CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0 - STU 2.1 United States of America flag

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 2.1.0 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

Table of Contents

Page standards status: Informative
.. 0 Table of Contents
... 1 Home
... 2 Background
... 3 Use Case
... 4 Conformance Requirements
... 5 General Guidance
... 6 Common Payer Consumer Data Set (CPCDS)
... 7 Terminology Licensure
... 8 Artifacts Summary
.... 8.1 C4BB CapabilityStatement
.... 8.2 Coverage_Payor
.... 8.3 ExplanationOfBenefit_BillablePeriodStart
.... 8.4 ExplanationOfBenefit_Careteam
.... 8.5 ExplanationOfBenefit_Coverage
.... 8.6 ExplanationOfBenefit_Identifier
.... 8.7 ExplanationOfBenefit_Insurer
.... 8.8 ExplanationOfBenefit_Organization
.... 8.9 ExplanationOfBenefit_Patient
.... 8.10 ExplanationOfBenefit_Practitioner
.... 8.11 ExplanationOfBenefit_Provider
.... 8.12 ExplanationOfBenefit_ServiceDate
.... 8.13 ExplanationOfBenefit_ServiceStartDate
.... 8.14 ExplanationOfBenefit_Type
.... 8.15 C4BB Explanation Of Benefit
.... 8.16 C4BB ExplanationOfBenefit Inpatient Institutional Basis
.... 8.17 C4BB ExplanationOfBenefit Oral Basis
.... 8.18 C4BB ExplanationOfBenefit Outpatient Institutional Basis
.... 8.19 C4BB ExplanationOfBenefit Pharmacy Basis
.... 8.20 C4BB ExplanationOfBenefit Professional NonClinician Basis
.... 8.21 C4BB Coverage
.... 8.22 C4BB ExplanationOfBenefit Inpatient Institutional
.... 8.23 C4BB ExplanationOfBenefit Oral
.... 8.24 C4BB ExplanationOfBenefit Outpatient Institutional
.... 8.25 C4BB ExplanationOfBenefit Pharmacy
.... 8.26 C4BB ExplanationOfBenefit Professional NonClinician
.... 8.27 C4BB Organization
.... 8.28 C4BB Patient
.... 8.29 C4BB Practitioner
.... 8.30 C4BB RelatedPerson
.... 8.31 ADA Code on Dental Procedures and Nomenclature Value Set
.... 8.32 American Dental Association Universal Numbering Value Set
.... 8.33 C4BB Adjudication Category Discriminator Value Set
.... 8.34 C4BB Adjudication Value Set
.... 8.35 C4BB Ambulance Transport Reasons Value Set
.... 8.36 C4BB Claim Identifier Type Value Set
.... 8.37 C4BB Claim Inpatient Institutional Diagnosis Type Value Set
.... 8.38 C4BB Claim Institutional Care Team Role Value Set
.... 8.39 C4BB Claim Outpatient Institutional Diagnosis Type Value Set
.... 8.40 C4BB Claim Pharmacy CareTeam Role Value Set
.... 8.41 C4BB Claim Procedure Type Value Set
.... 8.42 C4BB Claim Professional And Non Clinician Care Team Role Value Set
.... 8.43 C4BB Claim Professional And Non Clinician Diagnosis Type Value Set
.... 8.44 C4BB Institutional Claim SubType Value Set
.... 8.45 C4BB Organization Identifier Type Value Set
.... 8.46 C4BB Patient Identifier Type Value Set
.... 8.47 C4BB Payee Type Value Set
.... 8.48 C4BB Payer Benefit Payment Status Value Set
.... 8.49 C4BB Payer Claim Payment Status Code Value Set
.... 8.50 C4BB Payer Provider Network Status Value Set
.... 8.51 C4BB Practitioner Identifier Type Value Set
.... 8.52 C4BB Professional And Non Clinician Claim SubType Value Set
.... 8.53 C4BB Professional And Non Clinician Claim Type Value Set
.... 8.54 C4BB Related Claim Relationship Codes Value Set
.... 8.55 C4BB SupportingInfo Type Value Set
.... 8.56 C4BB Total Category Discriminator Value Set
.... 8.57 C4BB Transportation Services Categories Value Set
.... 8.58 CMS Place of Service Codes (POS) Value Set
.... 8.59 CMS Present On Admission Indicator Codes Value Set
.... 8.60 Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set
.... 8.61 MS-DRGs - AP-DRGs - APR-DRGs Value Set
.... 8.62 National Drug Code (NDC) Value Set
.... 8.63 NCPDP Brand Generic Indicator Value Set
.... 8.64 NCPDP Compound Code Value Set
.... 8.65 NCPDP Dispense As Written (DAW)/Product Selection Code Value Set
.... 8.66 NCPDP Prescription Origin Code Value Set
.... 8.67 NCPDP Reject Code Value Set
.... 8.68 NDC or Compound Value Set
.... 8.69 NUBC Patient Discharge Status Codes Value Set
.... 8.70 NUBC Point Of Origin Value Set
.... 8.71 NUBC Priority (Type) of Admission or Visit Value Set
.... 8.72 NUBC Revenue Codes Value Set
.... 8.73 NUBC Type of Bill Codes Value Set
.... 8.74 Oral Body Site Value Set
.... 8.75 Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set
.... 8.76 Procedure Codes - AMA CPT - CMS HCPCS Value Set
.... 8.77 Procedure Codes - International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - ICD-10 Procedure Value Set
.... 8.78 Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set
.... 8.79 US Surface Codes Set Value Set
.... 8.80 X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set
.... 8.81 C4BB Adjudication Code System
.... 8.82 C4BB Adjudication Discriminator Code System
.... 8.83 C4BB Claim Care Team Role Code System
.... 8.84 C4BB Claim Diagnosis Type Code System
.... 8.85 C4BB Claim Procedure Type Code System
.... 8.86 C4BB Compound Literal Code System
.... 8.87 C4BB Identifier Type Code System
.... 8.88 C4BB Institutional Claim SubType Code System
.... 8.89 C4BB Payee Type Code System
.... 8.90 C4BB Payer Adjudication Status Code System
.... 8.91 C4BB Related Claim Relationship Code System
.... 8.92 C4BB Supporting Info Type Code System
.... 8.93 BB-EOBOral1-nonfinancial
.... 8.94 BB-EOBOral2-nonfinancial
.... 8.95 BB-EOBPharmacy1-nonfinancial
.... 8.96 Coverage Example 1
.... 8.97 Coverage Example 2
.... 8.98 Coverage Example 3
.... 8.99 Dental Coverage Example1
.... 8.100 Dental Payer1
.... 8.101 Dental Provider 1
.... 8.102 EOB Inpatient Example 2
.... 8.103 EOB Inpatient Example1
.... 8.104 EOB Inpatient Institutional - Example 1 - Nonfinancial
.... 8.105 EOB Inpatient Institutional - Example 2 - Nonfinancial
.... 8.106 EOB Oral Example 1
.... 8.107 EOB Oral Example 2
.... 8.108 EOB Outpatient Institutional - Example 1
.... 8.109 EOB Outpatient Institutional - Example 1 - Nonfinancial
.... 8.110 EOB Outpatient Institutional - Example 2
.... 8.111 EOB Outpatient Institutional - Example 2 - Nonfinancial
.... 8.112 EOB Pharmacy Example1
.... 8.113 EOB Professional - Example 1
.... 8.114 EOB Professional - Example 1 - Nonfinancial
.... 8.115 EOB Professional - Example 2
.... 8.116 EOB Professional - Example 2 - Nonfinancial
.... 8.117 EOB Professional - Transportation 1
.... 8.118 EOB Professional - Transportation 1 - Nonfinancial
.... 8.119 Patient Example 1
.... 8.120 Patient Example 2
.... 8.121 Payer 1
.... 8.122 Payer 2
.... 8.123 Practitioner Example 1
.... 8.124 Practitioner Example 2
.... 8.125 Practitioner Example 3
.... 8.126 Practitioner4
.... 8.127 Provider Organization 1
.... 8.128 Provider Organization 2
.... 8.129 Provider Organization 3
.... 8.130 Provider Organization 4
.... 8.131 Provider Organization 5
.... 8.132 Provider Organization 6
.... 8.133 Provider Transportation Organization Example 1
.... 8.134 Related Person 1
... 9 Search Parameters
... 10 Security and Privacy Considerations
... 11 Downloads
... 12 Change Notes