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-EOBProfessional2-nonfinancial
Last updated: 2020-10-20 14:46:05-0400;
Information Source: Organization/PayerOrganizationExample1
Profile: C4BB ExplanationOfBenefit Professional NonClinician 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/ProfessionalEOBExample1
status: Active
type: Professional
use: Claim
patient: Johnny Example1 Male, DoB: 1986-01-01 ( Member Number)
billablePeriod: 2020-08-04 --> 2020-08-04
created: 2020-08-24 00:00:00-0400
insurer: UPMC Health Plan
provider: Organization Orange Medical Group
| Type | Party |
| Any benefit payable will be paid to the provider (Assignment of Benefit). | Organization Orange Medical Group |
outcome: Processing Complete
careTeam
sequence: 1
provider: Practitioner John Smith
role: The primary care provider.
careTeam
sequence: 2
provider: Practitioner Jack Brown
role: The referring physician
| Sequence | Category | Timing[x] |
| 1 | Date the claim was received by the payer. | 2020-08-24 |
diagnosis
sequence: 1
diagnosis: Athscl native arteries of left leg w ulceration of unsp site
type: The single medical diagnosis that is most relevant to the patient's chief complaint or need for treatment.
diagnosis
sequence: 2
diagnosis: Non-prs chronic ulc unsp prt of l low leg w unsp severity
type: Required when necessary to report additional diagnoses on professional and non-clinician claims
item
sequence: 1
productOrService: Angiography, extremity, unilateral, radiological supervision and interpretation
serviced: 2020-08-04
location: HOSPITAL - INPATIENT HOSPITAL
Adjudications
Category Reason Benefit Payment Status In Network
item
sequence: 2
productOrService: Angiography, extremity, unilateral, radiological supervision and interpretation
serviced: 2020-08-04
location: HOSPITAL - INPATIENT HOSPITAL
Adjudications
Category Reason Benefit Payment Status In Network
item
sequence: 3
productOrService: Angiography, extremity, unilateral, radiological supervision and interpretation
serviced: 2020-08-04
location: HOSPITAL - INPATIENT HOSPITAL
Adjudications
Category Reason Benefit Payment Status In Network
item
sequence: 4
productOrService: Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty
serviced: 2020-08-04
location: HOSPITAL - INPATIENT HOSPITAL
Adjudications
Category Reason Benefit Payment Status In Network
item
sequence: 5
productOrService: Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty
serviced: 2020-08-04
location: HOSPITAL - INPATIENT HOSPITAL
Adjudications
Category Reason Benefit Payment Status In Network
item
sequence: 6
productOrService: Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty
serviced: 2020-08-04
location: HOSPITAL - INPATIENT HOSPITAL
Adjudications
Category Reason Benefit Payment Status In Network
| Category | Reason |
| Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission. | Indicates the provider was in network for the service |
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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