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 https://github.com/HL7/carin-bb/ and changes regularly. See the Directory of published versions

Profiles defined as part of this Guide



Profiles

Name Description
CARINBBCoverage

CARIN Blue Button Coverage Profile

CARINBBExplanationOfBenefit

This profile is built upon the ExplanationOfBenefit Resource. It includes constraints that are common to the more specific EOB profiles defined in this IG. Each of the more specific EOB profiles builds upon this profile. MustSupport implementer guidance is included in this base profile (e.g. profile flags). The more specific EOB profiles therefore inherit MustSupport guidance from this base profile.

CARINBBExplanationOfBenefitInpatientFacility

This profile is built upon the CARINBBExplanationOfBenefit Profile. The profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for inpatient services, which may include the use of equipment and supplies, laboratory services, radiology services and other charges. Inpatient claims are submitted for services rendered at a facility as part of an overnight stay. The claims data is based on the institutional claim format UB-04, submission standards adopted by the Department of Health and Human Services as form CMS-1450.

CARINBBExplanationOfBenefitOutpatientFacility

This profile is built upon the CARINBBExplanationOfBenefit Profile. The profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for outpatient services, which may include including the use of equipment and supplies, laboratory services, radiology services and other charges. Outpatient claims are submitted for services rendered at a facility that are not part of an overnight stay. The claims data is based on the institutional claim form UB-04, submission standards adopted by the Department of Health and Human Services as form CMS-1450.

CARINBBExplanationOfBenefitPharmacy

This profile is built upon the CARINBBExplanationOfBenefit Profile. The profile is used for Explanation of Benefits (EOBs) based on claims submitted by retail pharmacies. The claims data is based on submission standards adopted by the Department of Health and Human Services defined by NCPDP (National Council for Prescription Drug Program)

CARINBBExplanationOfBenefitProfessionalNonClinician

This profile is built upon the CARINBBExplanationOfBenefit Profile. The profile is used for Explanation of Benefits (EOBs) based on claims submitted by physicians, suppliers and other non-institutional providers for professional services. These services may be rendered in inpatient or outpatient, including office locations. The claims data is based on the professional claim form 1500, submission standards adopted by the Department of Health and Human Services as form CMS-1500.

CARINBBOrganization

This profile builds on the USCoreOrganization Profile. It includes additional constraints relevant for the use cases addressed by this IG.

CARINBBPatient

This profile builds on USCorePatient Profile. It includes additional constraints relevant for the use cases addressed by this IG.

CARINBBPractitionerRole

This profile builds on USCorePractitionerRole Profile. It includes additional constraints relevant for the use cases addressed by this IG.

CARINBBRelatedPerson

This profile builds on the RelatedPerson Resource. It includes additional constraints relevant for the use cases addressed by this IG.

Extensions

No extensions are defined for this implementation guide