CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0-snapshot1 - STU 2.1 prepublication draft
CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
2.1.0-snapshot1 - STU 2.1 prepublication draft
This page is part of the CARIN Blue Button Implementation Guide (v2.1.0-snapshot1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions
| Page standards status: Trial-use |
<CapabilityStatement xmlns="http://hl7.org/fhir">
<id value="c4bb"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CapabilityStatement c4bb</b></p><a name="c4bb"> </a><a name="hcc4bb"> </a><a name="c4bb-en-US"> </a><h2 id="title">C4BB CapabilityStatement</h2><ul><li>Implementation Guide Version: 2.1.0-snapshot1 </li><li>FHIR Version: 4.0.1 </li><li>Supported Formats: <code>xml</code>, <code>json</code></li><li>Supported Patch Formats: </li><li>Published on: 2022-09-11 </li><li>Published by: HL7 International / Financial Management </li></ul><blockquote class="impl-note"><p><strong>Note to Implementers: FHIR Capabilities</strong></p><p>Any FHIR capability may be 'allowed' by the system unless explicitly marked as 'SHALL NOT'. A few items are marked as MAY in the Implementation Guide to highlight their potential relevance to the use case.</p></blockquote><h3 id="shallIGs">SHALL Support the Following Implementation Guides</h3><ul><li><a href="index.html">http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb</a></li></ul><h2 id="rest">FHIR RESTful Capabilities</h2><div class="panel panel-default"><div class="panel-heading"><h3 id="mode1" class="panel-title">Mode: <code>server</code></h3></div><div class="panel-body"><div><p>The C4BB Server <strong>SHALL</strong>:</p>
<ol>
<li>Support all profiles defined in this Implementation Guide..</li>
<li>Implement the RESTful behavior according to the FHIR specification.</li>
<li>Return the following response classes:
<ul>
<li>(Status 400): invalid parameter</li>
<li>(Status 401/4xx): unauthorized request</li>
<li>(Status 403): insufficient scope</li>
<li>(Status 404): unknown resource</li>
<li>(Status 410): deleted resource.</li>
</ul>
</li>
<li>Support json source formats for all CARIN-BB interactions.</li>
<li>Identify the CARIN-BB profiles supported as part of the FHIR <code>meta.profile</code> attribute for each instance.</li>
<li>Support the searchParameters on each profile individually and in combination.</li>
</ol>
<p>The C4BB Server <strong>SHOULD</strong>:</p>
<ol>
<li>Support xml source formats for all C4BB interactions.</li>
</ol>
</div><div class="lead"><em>Security</em></div><blockquote><div><ol>
<li>See the <a href="Security_And_Privacy_Considerations.html">General Security Considerations</a> section for requirements and recommendations.</li>
<li>A server <strong>SHALL</strong> reject any unauthorized requests by returning an HTTP 401 "Unauthorized", HTTP 403 "Forbidden", or HTTP 404 "Not Found" .</li>
</ol>
</div></blockquote><div class="lead"><em>Summary of System-wide Interactions</em></div></div></div><h3 id="resourcesCap1">Capabilities by Resource/Profile</h3><h4 id="resourcesSummary1">Summary</h4><p>The summary table lists the resources that are part of this configuration, and for each resource it lists:</p><ul><li>The relevant profiles (if any)</li><li>The interactions supported by each resource (<b><span class="bg-info">R</span></b>ead, <b><span class="bg-info">S</span></b>earch, <b><span class="bg-info">U</span></b>pdate, and <b><span class="bg-info">C</span></b>reate, are always shown, while <b><span class="bg-info">VR</span></b>ead, <b><span class="bg-info">P</span></b>atch, <b><span class="bg-info">D</span></b>elete, <b><span class="bg-info">H</span></b>istory on <b><span class="bg-info">I</span></b>nstance, or <b><span class="bg-info">H</span></b>istory on <b><span class="bg-info">T</span></b>ype are only present if at least one of the resources has support for them.</li><li><span>The required, recommended, and some optional search parameters (if any). </span></li><li>The linked resources enabled for <code>_include</code></li><li>The other resources enabled for <code>_revinclude</code></li><li>The operations on the resource (if any)</li></ul><div class="table-responsive"><table class="table table-condensed table-hover"><thead><tr><th><b>Resource Type</b></th><th><b>Profile</b></th><th class="text-center"><b title="GET a resource (read interaction)">R</b></th><th class="text-center"><b title="GET past versions of resources (vread interaction)">V-R</b></th><th class="text-center"><b title="GET all set of resources of the type (search interaction)">S</b></th><th class="text-center"><b title="PUT a new resource version (update interaction)">U</b></th><th class="text-center"><b title="POST a new resource (create interaction)">C</b></th><th><b title="Required and recommended search parameters">Searches</b></th><th><code><b>_include</b></code></th><th><code><b>_revinclude</b></code></th><th><b>Operations</b></th></tr></thead><tbody><tr><td><a href="#Coverage1-1">Coverage</a></td><td>Supported Profiles<br/> <a href="StructureDefinition-C4BB-Coverage.html">C4BB Coverage</a></td><td>y</td><td class="text-center">y</td><td class="text-center">y</td><td class="text-center"></td><td class="text-center"></td><td>_id, _lastUpdated</td><td><code>Coverage:payor</code></td><td/><td/></tr><tr><td><a href="#ExplanationOfBenefit1-2">ExplanationOfBenefit</a></td><td>Supported Profiles<br/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit.html">C4BB Explanation Of Benefit</a><br/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html">C4BB ExplanationOfBenefit Inpatient Institutional</a><br/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html">C4BB ExplanationOfBenefit Outpatient Institutional</a><br/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html">C4BB ExplanationOfBenefit Oral</a><br/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy.html">C4BB ExplanationOfBenefit Pharmacy</a><br/> <a href="StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html">C4BB ExplanationOfBenefit Professional NonClinician</a></td><td>y</td><td class="text-center">y</td><td class="text-center">y</td><td class="text-center"></td><td class="text-center"></td><td>_id, patient, _lastUpdated, type, identifier, service-date, service-start-date, billable-period-start</td><td><code>ExplanationOfBenefit:patient</code>, <code>ExplanationOfBenefit:provider</code>, <code>ExplanationOfBenefit:care-team</code>, <code>ExplanationOfBenefit:coverage</code>, <code>ExplanationOfBenefit:insurer</code>, <code>ExplanationOfBenefit:payee</code>, <code>ExplanationOfBenefit:*</code></td><td/><td/></tr><tr><td><a href="#Organization1-3">Organization</a></td><td>Supported Profiles<br/> <a href="StructureDefinition-C4BB-Organization.html">C4BB Organization</a></td><td>y</td><td class="text-center">y</td><td class="text-center">y</td><td class="text-center"></td><td class="text-center"></td><td>_id, _lastUpdated</td><td/><td/><td/></tr><tr><td><a href="#Patient1-4">Patient</a></td><td>Supported Profiles<br/> <a href="StructureDefinition-C4BB-Patient.html">C4BB Patient</a></td><td>y</td><td class="text-center">y</td><td class="text-center">y</td><td class="text-center"></td><td class="text-center"></td><td>_id, _lastUpdated</td><td/><td/><td/></tr><tr><td><a href="#Practitioner1-5">Practitioner</a></td><td>Supported Profiles<br/> <a href="StructureDefinition-C4BB-Practitioner.html">C4BB Practitioner</a></td><td>y</td><td class="text-center">y</td><td class="text-center">y</td><td class="text-center"></td><td class="text-center"></td><td>_id, _lastUpdated</td><td/><td/><td/></tr><tr><td><a href="#RelatedPerson1-6">RelatedPerson</a></td><td>Supported Profiles<br/> <a href="StructureDefinition-C4BB-RelatedPerson.html">C4BB RelatedPerson</a></td><td>y</td><td class="text-center">y</td><td class="text-center">y</td><td class="text-center"></td><td class="text-center"></td><td>_id, _lastUpdated</td><td/><td/><td/></tr></tbody></table></div><hr/><div class="panel panel-default"><div class="panel-heading"><h4 id="Coverage1-1" class="panel-title"><span style="float: right;">Resource Conformance: SHALL </span>Coverage</h4></div><div class="panel-body"><div class="container"><div class="row"><div class="col-lg-4"><span class="lead">Core FHIR Resource</span><br/><a href="http://hl7.org/fhir/R4/coverage.html">Coverage</a></div><div class="col-lg-4"><span class="lead">Reference Policy</span><br/><code>resolves</code></div><div class="col-lg-4"><span class="lead">Interaction summary</span><br/><ul><li><strong>SHALL</strong>support <code>search-type</code>, <code>read</code>.</li><li><strong>SHOULD</strong>support <code>vread</code>.</li></ul></div></div><p/><div class="row"><div class="col-6"><span class="lead">Supported Profiles</span><p><a href="StructureDefinition-C4BB-Coverage.html">http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage</a></p></div></div><p/><div class="row"><div class="col-lg-7"><span class="lead">Search Parameters</span><table class="table table-condensed table-hover"><thead><tr><th>Conformance</th><th>Parameter</th><th>Type</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_id</a></td><td><code>token</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#id</p>
</div></td></tr><tr><td><b>SHOULD</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_lastUpdated</a></td><td><code>date</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#lastUpdated</p>
</div></td></tr></tbody></table></div><div class="col-lg-5"> </div></div></div></div></div><div class="panel panel-default"><div class="panel-heading"><h4 id="ExplanationOfBenefit1-2" class="panel-title"><span style="float: right;">Resource Conformance: SHALL </span>ExplanationOfBenefit</h4></div><div class="panel-body"><div class="container"><div class="row"><div class="col-lg-4"><span class="lead">Core FHIR Resource</span><br/><a href="http://hl7.org/fhir/R4/explanationofbenefit.html">ExplanationOfBenefit</a></div><div class="col-lg-4"><span class="lead">Reference Policy</span><br/><code>resolves</code></div><div class="col-lg-4"><span class="lead">Interaction summary</span><br/><ul><li><strong>SHALL</strong>support <code>search-type</code>, <code>read</code>.</li><li><strong>SHOULD</strong>support <code>vread</code>.</li></ul></div></div><p/><div class="row"><div class="col-6"><span class="lead">Supported Profiles</span><p><a href="StructureDefinition-C4BB-ExplanationOfBenefit.html">http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit</a><br/><a href="StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html">http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional</a><br/><a href="StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html">http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional</a><br/><a href="StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html">http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral</a><br/><a href="StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy.html">http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy</a><br/><a href="StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html">http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician</a></p></div></div><p/><div class="row"><div class="col-12"><span class="lead">Documentation</span><blockquote><div><p>When an EOB references another resource (e.g., Patient or Practitioner), the reference may be versioned or versionless. Payers SHALL use versioned references whenever they maintain point-in-time data (data that was effective as of the date of service or date of admission on the claim), but MAY use versionless references when they do not maintain versioned data. Clients MAY request referenced resources as part of an EOB search (by supplying the _include parameter) or directly using read or vread. Payers SHALL support both approaches, and SHALL return the same content for referenced resources in either case. “:iterate" should be used if you request to include Coverage:payor in the EOB response bundle, e.g. GET [base]/ExplanationOfBenefit?_id[parameter=value]&_include=ExplanationOfBenefit:coverage&_include:iterate=Coverage:payor.</p>
</div></blockquote></div></div><div class="row"><div class="col-lg-7"><span class="lead">Search Parameters</span><table class="table table-condensed table-hover"><thead><tr><th>Conformance</th><th>Parameter</th><th>Type</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_id</a></td><td><code>token</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#id</p>
</div></td></tr><tr><td><b>SHALL</b></td><td><a href="SearchParameter-explanationofbenefit-patient.html">patient</a></td><td><code>reference</code></td><td><div/></td></tr><tr><td><b>SHALL</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_lastUpdated</a></td><td><code>date</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#lastUpdated</p>
</div></td></tr><tr><td><b>SHALL</b></td><td><a href="SearchParameter-explanationofbenefit-type.html">type</a></td><td><code>token</code></td><td><div/></td></tr><tr><td><b>SHALL</b></td><td><a href="SearchParameter-explanationofbenefit-identifier.html">identifier</a></td><td><code>token</code></td><td><div/></td></tr><tr><td><b>SHALL</b></td><td><a href="SearchParameter-explanationofbenefit-service-date.html">service-date</a></td><td><code>date</code></td><td><div/></td></tr><tr><td><b>SHALL</b></td><td><a href="SearchParameter-explanationofbenefit-service-start-date.html">service-start-date</a></td><td><code>date</code></td><td><div/></td></tr><tr><td><b>SHALL</b></td><td><a href="SearchParameter-explanationofbenefit-billable-period-start.html">billable-period-start</a></td><td><code>date</code></td><td><div/></td></tr></tbody></table></div><div class="col-lg-5"> </div></div></div></div></div><div class="panel panel-default"><div class="panel-heading"><h4 id="Organization1-3" class="panel-title"><span style="float: right;">Resource Conformance: SHOULD </span>Organization</h4></div><div class="panel-body"><div class="container"><div class="row"><div class="col-lg-4"><span class="lead">Core FHIR Resource</span><br/><a href="http://hl7.org/fhir/R4/organization.html">Organization</a></div><div class="col-lg-4"><span class="lead">Reference Policy</span><br/><code>resolves</code></div><div class="col-lg-4"><span class="lead">Interaction summary</span><br/><ul><li><strong>SHALL</strong>support <code>read</code>.</li><li><strong>SHOULD</strong>support <code>vread</code>.</li><li><strong>MAY</strong>support <code>search-type</code>.</li></ul></div></div><p/><div class="row"><div class="col-6"><span class="lead">Supported Profiles</span><p><a href="StructureDefinition-C4BB-Organization.html">http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization</a></p></div></div><p/><div class="row"><div class="col-lg-7"><span class="lead">Search Parameters</span><table class="table table-condensed table-hover"><thead><tr><th>Conformance</th><th>Parameter</th><th>Type</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_id</a></td><td><code>token</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#id</p>
</div></td></tr><tr><td><b>SHOULD</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_lastUpdated</a></td><td><code>date</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#lastUpdated</p>
</div></td></tr></tbody></table></div><div class="col-lg-5"> </div></div></div></div></div><div class="panel panel-default"><div class="panel-heading"><h4 id="Patient1-4" class="panel-title"><span style="float: right;">Resource Conformance: SHALL </span>Patient</h4></div><div class="panel-body"><div class="container"><div class="row"><div class="col-lg-4"><span class="lead">Core FHIR Resource</span><br/><a href="http://hl7.org/fhir/R4/patient.html">Patient</a></div><div class="col-lg-4"><span class="lead">Reference Policy</span><br/><code>resolves</code></div><div class="col-lg-4"><span class="lead">Interaction summary</span><br/><ul><li><strong>SHALL</strong>support <code>read</code>.</li><li><strong>SHOULD</strong>support <code>vread</code>.</li><li><strong>MAY</strong>support <code>search-type</code>.</li></ul></div></div><p/><div class="row"><div class="col-6"><span class="lead">Supported Profiles</span><p><a href="StructureDefinition-C4BB-Patient.html">http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient</a></p></div></div><p/><div class="row"><div class="col-lg-7"><span class="lead">Search Parameters</span><table class="table table-condensed table-hover"><thead><tr><th>Conformance</th><th>Parameter</th><th>Type</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_id</a></td><td><code>token</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#id</p>
</div></td></tr><tr><td><b>SHOULD</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_lastUpdated</a></td><td><code>date</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#lastUpdated</p>
</div></td></tr></tbody></table></div><div class="col-lg-5"> </div></div></div></div></div><div class="panel panel-default"><div class="panel-heading"><h4 id="Practitioner1-5" class="panel-title"><span style="float: right;">Resource Conformance: SHOULD </span>Practitioner</h4></div><div class="panel-body"><div class="container"><div class="row"><div class="col-lg-4"><span class="lead">Core FHIR Resource</span><br/><a href="http://hl7.org/fhir/R4/practitioner.html">Practitioner</a></div><div class="col-lg-4"><span class="lead">Reference Policy</span><br/><code>resolves</code></div><div class="col-lg-4"><span class="lead">Interaction summary</span><br/><ul><li><strong>SHALL</strong>support <code>read</code>.</li><li><strong>SHOULD</strong>support <code>vread</code>.</li><li><strong>MAY</strong>support <code>search-type</code>.</li></ul></div></div><p/><div class="row"><div class="col-6"><span class="lead">Supported Profiles</span><p><a href="StructureDefinition-C4BB-Practitioner.html">http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner</a></p></div></div><p/><div class="row"><div class="col-lg-7"><span class="lead">Search Parameters</span><table class="table table-condensed table-hover"><thead><tr><th>Conformance</th><th>Parameter</th><th>Type</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_id</a></td><td><code>token</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#id</p>
</div></td></tr><tr><td><b>SHOULD</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_lastUpdated</a></td><td><code>date</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#lastUpdated</p>
</div></td></tr></tbody></table></div><div class="col-lg-5"> </div></div></div></div></div><div class="panel panel-default"><div class="panel-heading"><h4 id="RelatedPerson1-6" class="panel-title"><span style="float: right;">Resource Conformance: SHOULD </span>RelatedPerson</h4></div><div class="panel-body"><div class="container"><div class="row"><div class="col-lg-4"><span class="lead">Core FHIR Resource</span><br/><a href="http://hl7.org/fhir/R4/relatedperson.html">RelatedPerson</a></div><div class="col-lg-4"><span class="lead">Reference Policy</span><br/><code>resolves</code></div><div class="col-lg-4"><span class="lead">Interaction summary</span><br/><ul><li><strong>SHALL</strong>support <code>read</code>.</li><li><strong>SHOULD</strong>support <code>vread</code>.</li><li><strong>MAY</strong>support <code>search-type</code>.</li></ul></div></div><p/><div class="row"><div class="col-6"><span class="lead">Supported Profiles</span><p><a href="StructureDefinition-C4BB-RelatedPerson.html">http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-RelatedPerson</a></p></div></div><p/><div class="row"><div class="col-lg-7"><span class="lead">Search Parameters</span><table class="table table-condensed table-hover"><thead><tr><th>Conformance</th><th>Parameter</th><th>Type</th><th>Documentation</th></tr></thead><tbody><tr><td><b>SHALL</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_id</a></td><td><code>token</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#id</p>
</div></td></tr><tr><td><b>SHOULD</b></td><td><a href="http://hl7.org/fhir/R4/resource.html#search">_lastUpdated</a></td><td><code>date</code></td><td><div><p>http://hl7.org/fhir/R4/search.html#lastUpdated</p>
</div></td></tr></tbody></table></div><div class="col-lg-5"> </div></div></div></div></div></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
<valueCode value="fm"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="trial-use">
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom">
<valueCanonical
value="http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb"/>
</extension>
</valueCode>
</extension>
<url value="http://hl7.org/fhir/us/carin-bb/CapabilityStatement/c4bb"/>
<version value="2.1.0-snapshot1"/>
<name value="CarinBbCapabilityStatement"/>
<title value="C4BB CapabilityStatement"/>
<status value="active"/>
<experimental value="false"/>
<date value="2022-09-11"/>
<publisher value="HL7 International / Financial Management"/>
<contact>
<name value="HL7 International / Financial Management"/>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/fm"/>
</telecom>
<telecom>
<system value="email"/>
<value value="fm@lists.HL7.org"/>
</telecom>
</contact>
<description
value="This Section describes the expected capabilities of the C4BB Server actor which is responsible for providing responses to the queries submitted by the C4BB Requestors.
The EOB Resource is the focal Consumer-Directed Payer Data Exchange (CDPDE) Resource. Several Reference Resources are defined directly/indirectly from the EOB: Coverage, Patient, Organization (Payer ID), Practioner, and Organization (Facility).
The Coverage Reference Resource SHALL be returned with data that was effective as of the date of service of the claim; for example, the data will reflect the employer name in effect at that time. However, for other reference resources, payers MAY decide to provide either the data that was in effect as of the date of service or the current data. All reference resources within the EOB will have meta.lastUpdated flagged as must support. Payers SHALL provide the last time the data was updated or the date of creation in the payers system of record, whichever comes last. Apps will use the meta.lastUpdated values to determine if the reference resources are as of the current date or date of service."/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
</coding>
</jurisdiction>
<kind value="requirements"/>
<fhirVersion value="4.0.1"/>
<format value="xml"/>
<format value="json"/>
<implementationGuide
value="http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb"/>
<rest>
<mode value="server"/>
<documentation
value="The C4BB Server **SHALL**:
1. Support all profiles defined in this Implementation Guide..
2. Implement the RESTful behavior according to the FHIR specification.
3. Return the following response classes:
- (Status 400): invalid parameter
- (Status 401/4xx): unauthorized request
- (Status 403): insufficient scope
- (Status 404): unknown resource
- (Status 410): deleted resource.
4. Support json source formats for all CARIN-BB interactions.
5. Identify the CARIN-BB profiles supported as part of the FHIR `meta.profile` attribute for each instance.
6. Support the searchParameters on each profile individually and in combination.
The C4BB Server **SHOULD**:
1. Support xml source formats for all C4BB interactions.
"/>
<security>
<description
value="1. See the [General Security Considerations](Security_And_Privacy_Considerations.html) section for requirements and recommendations.
2. A server **SHALL** reject any unauthorized requests by returning an HTTP 401 "Unauthorized", HTTP 403 "Forbidden", or HTTP 404 "Not Found" ."/>
</security>
<resource>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<type value="Coverage"/>
<supportedProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"/>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<code value="search-type"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<code value="read"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<code value="vread"/>
</interaction>
<referencePolicy value="resolves"/>
<searchInclude value="Coverage:payor"/>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="_id"/>
<definition value="http://hl7.org/fhir/SearchParameter/Resource-id"/>
<type value="token"/>
<documentation value="http://hl7.org/fhir/R4/search.html#id"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<name value="_lastUpdated"/>
<definition
value="http://hl7.org/fhir/SearchParameter/Resource-lastUpdated"/>
<type value="date"/>
<documentation
value="http://hl7.org/fhir/R4/search.html#lastUpdated"/>
</searchParam>
</resource>
<resource>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<type value="ExplanationOfBenefit"/>
<supportedProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit"/>
<supportedProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional"/>
<supportedProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"/>
<supportedProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral"/>
<supportedProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy"/>
<supportedProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"/>
<documentation
value="When an EOB references another resource (e.g., Patient or Practitioner), the reference may be versioned or versionless. Payers SHALL use versioned references whenever they maintain point-in-time data (data that was effective as of the date of service or date of admission on the claim), but MAY use versionless references when they do not maintain versioned data. Clients MAY request referenced resources as part of an EOB search (by supplying the _include parameter) or directly using read or vread. Payers SHALL support both approaches, and SHALL return the same content for referenced resources in either case. “:iterate" should be used if you request to include Coverage:payor in the EOB response bundle, e.g. GET [base]/ExplanationOfBenefit?_id[parameter=value]&_include=ExplanationOfBenefit:coverage&_include:iterate=Coverage:payor."/>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<code value="search-type"/>
<documentation
value="_include:* SHALL be supported.
Note: `_include=ExplanationOfBenefit:*` means, at minimum, the resources that are included as reference type search parameters for the ExplanationOfBenefit resource on the server. Servers claiming compliance to this guide will, at minimum, support the include of `patient`, `provider`, `care-team`, `coverage`, `insurer`, and `payee`, and will support returning all of them in support `ExplanationOfBenefit:*` (Where not supported only as contained resources). Not all of these are defined as required search parameters, but are defined as part of the _include requirement. For example, the insurer search parameter is not required because in the context of the use case, it is anticipated there will ever be one insurer. It however must be returned in the `_include=ExplanationOfBenefit:*` results. The means in which this is done (including defining all of the _include as search parameters) is not defined.
"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<code value="read"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<code value="vread"/>
</interaction>
<referencePolicy value="resolves"/>
<searchInclude value="ExplanationOfBenefit:patient"/>
<searchInclude value="ExplanationOfBenefit:provider"/>
<searchInclude value="ExplanationOfBenefit:care-team"/>
<searchInclude value="ExplanationOfBenefit:coverage"/>
<searchInclude value="ExplanationOfBenefit:insurer"/>
<searchInclude value="ExplanationOfBenefit:payee"/>
<searchInclude value="ExplanationOfBenefit:*"/>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="_id"/>
<definition value="http://hl7.org/fhir/SearchParameter/Resource-id"/>
<type value="token"/>
<documentation value="http://hl7.org/fhir/R4/search.html#id"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="patient"/>
<definition
value="http://hl7.org/fhir/us/carin-bb/SearchParameter/explanationofbenefit-patient"/>
<type value="reference"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="_lastUpdated"/>
<definition
value="http://hl7.org/fhir/SearchParameter/Resource-lastUpdated"/>
<type value="date"/>
<documentation
value="http://hl7.org/fhir/R4/search.html#lastUpdated"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="type"/>
<definition
value="http://hl7.org/fhir/us/carin-bb/SearchParameter/explanationofbenefit-type"/>
<type value="token"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="identifier"/>
<definition
value="http://hl7.org/fhir/us/carin-bb/SearchParameter/explanationofbenefit-identifier"/>
<type value="token"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="service-date"/>
<definition
value="http://hl7.org/fhir/us/carin-bb/SearchParameter/explanationofbenefit-service-date"/>
<type value="date"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="service-start-date"/>
<definition
value="http://hl7.org/fhir/us/carin-bb/SearchParameter/explanationofbenefit-service-start-date"/>
<type value="date"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="billable-period-start"/>
<definition
value="http://hl7.org/fhir/us/carin-bb/SearchParameter/explanationofbenefit-billable-period-start"/>
<type value="date"/>
</searchParam>
</resource>
<resource>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<type value="Organization"/>
<supportedProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="MAY"/>
</extension>
<code value="search-type"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<code value="read"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<code value="vread"/>
</interaction>
<referencePolicy value="resolves"/>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="_id"/>
<definition value="http://hl7.org/fhir/SearchParameter/Resource-id"/>
<type value="token"/>
<documentation value="http://hl7.org/fhir/R4/search.html#id"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<name value="_lastUpdated"/>
<definition
value="http://hl7.org/fhir/SearchParameter/Resource-lastUpdated"/>
<type value="date"/>
<documentation
value="http://hl7.org/fhir/R4/search.html#lastUpdated"/>
</searchParam>
</resource>
<resource>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<type value="Patient"/>
<supportedProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"/>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="MAY"/>
</extension>
<code value="search-type"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<code value="read"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<code value="vread"/>
</interaction>
<referencePolicy value="resolves"/>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="_id"/>
<definition value="http://hl7.org/fhir/SearchParameter/Resource-id"/>
<type value="token"/>
<documentation value="http://hl7.org/fhir/R4/search.html#id"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<name value="_lastUpdated"/>
<definition
value="http://hl7.org/fhir/SearchParameter/Resource-lastUpdated"/>
<type value="date"/>
<documentation
value="http://hl7.org/fhir/R4/search.html#lastUpdated"/>
</searchParam>
</resource>
<resource>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<type value="Practitioner"/>
<supportedProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"/>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="MAY"/>
</extension>
<code value="search-type"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<code value="read"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<code value="vread"/>
</interaction>
<referencePolicy value="resolves"/>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="_id"/>
<definition value="http://hl7.org/fhir/SearchParameter/Resource-id"/>
<type value="token"/>
<documentation value="http://hl7.org/fhir/R4/search.html#id"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<name value="_lastUpdated"/>
<definition
value="http://hl7.org/fhir/SearchParameter/Resource-lastUpdated"/>
<type value="date"/>
<documentation
value="http://hl7.org/fhir/R4/search.html#lastUpdated"/>
</searchParam>
</resource>
<resource>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<type value="RelatedPerson"/>
<supportedProfile
value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-RelatedPerson"/>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="MAY"/>
</extension>
<code value="search-type"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<code value="read"/>
</interaction>
<interaction>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<code value="vread"/>
</interaction>
<referencePolicy value="resolves"/>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHALL"/>
</extension>
<name value="_id"/>
<definition value="http://hl7.org/fhir/SearchParameter/Resource-id"/>
<type value="token"/>
<documentation value="http://hl7.org/fhir/R4/search.html#id"/>
</searchParam>
<searchParam>
<extension
url="http://hl7.org/fhir/StructureDefinition/capabilitystatement-expectation">
<valueCode value="SHOULD"/>
</extension>
<name value="_lastUpdated"/>
<definition
value="http://hl7.org/fhir/SearchParameter/Resource-lastUpdated"/>
<type value="date"/>
<documentation
value="http://hl7.org/fhir/R4/search.html#lastUpdated"/>
</searchParam>
</resource>
</rest>
</CapabilityStatement>
IG © 2024+ HL7 International / Financial Management. Package hl7.fhir.us.carin-bb#2.1.0-snapshot1 based on FHIR 4.0.1. Generated 2024-07-27
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