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-EOBPharmacy1-nonfinancial
Last updated: 2019-12-12 09:14:11+0000; Language: en-US
Profile: C4BB ExplanationOfBenefit Pharmacy Basisversion: {0}2.1.0-snapshot1)
identifier: Unique Claim ID/AW123412341234123412341234123412
status: Active
type: Pharmacy
use: Claim
billablePeriod: 2019-10-30 --> 2019-10-31
created: 2019-07-02 00:00:00+0000
insurer: XXX Health Plan
provider: XXX Health Plan
outcome: Partial Processing
supportingInfo
sequence: 8
category: Days Supply
value: 30
supportingInfo
sequence: 6
category: DAW (Dispense As Written) Code
code: 7
supportingInfo
sequence: 4
category: Refill Number
value: 0
supportingInfo
sequence: 5
category: Refills Authorized
value: 0
supportingInfo
sequence: 2
category: Brand Generic Indicator
code: 2
supportingInfo
sequence: 3
category: Rx Origin Code
code: 1
supportingInfo
sequence: 7
category: Claim Received Date
timing: 2019-10-31
supportingInfo
sequence: 9
category: Compound Code
code: Dummy
| Sequence | ProductOrService | Serviced[x] |
| 1 | Prozac, 100 CAPSULE in 1 BOTTLE (0777-3105-02) (package) | 2019-07-02 |
| Category | Reason |
| Benefit Payment Status | In Network |
| Billing Network 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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