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: Informative |
Generated Narrative: ExplanationOfBenefit BB-EOBOutpatient2-nonfinancial
Last updated: 2020-10-13 11:10:24-0400;
Information Source: Organization/PayerOrganizationExample1
Profile: C4BB ExplanationOfBenefit Outpatient Institutional Basisversion: {0}2.1.0-snapshot1)
identifier: Indicates that the claim identifier is that assigned by a payer for a claim received from a provider or subscriber/OutpatientEOBExample1
status: Active
type: Institutional
subType: Outpatient
use: Claim
patient: Johnny Example1 Male, DoB: 1986-01-01 ( Member Number)
billablePeriod: 2020-09-29 --> 2020-09-29
created: 2020-10-10 00:00:00-0400
insurer: UPMC Health Plan
provider: Organization Black Medical Group
| Type | Party |
| Any benefit payable will be paid to the provider (Assignment of Benefit). | Organization White Medical Group |
outcome: Processing Complete
careTeam
sequence: 1
provider: Practitioner John Smith
role: The attending physician
careTeam
sequence: 2
provider: Practitioner Jane Williams
role: The referring physician
| Sequence | Category | Timing[x] |
| 1 | Claim Received Date | 2020-10-10 |
diagnosis
sequence: 1
diagnosis: Orthostatic hypotension
type: The single medical diagnosis that is most relevant to the patient's chief complaint or need for treatment.
diagnosis
sequence: 2
diagnosis: Orthostatic hypotension
type: Required when other conditions coexist or develop subsequently during the treatment
diagnosis
sequence: 3
diagnosis: Non-pressure chronic ulcer oth prt left foot w unsp severity
type: Required when other conditions coexist or develop subsequently during the treatment
diagnosis
sequence: 4
diagnosis: Peripheral vascular disease, unspecified
type: Required when other conditions coexist or develop subsequently during the treatment
item
sequence: 1
revenue: 0551
productOrService: Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
serviced: 2020-09-29
location: HOME
item
sequence: 2
revenue: 0023
productOrService: Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.
serviced: 2020-09-29
location: HOME
| Category | Reason |
| Benefit Payment Status | In Network |
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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