Generated Narrative: ImplementationGuide hl7.fhir.us.carin-bb

Language: en

CARINConsumerDirectedPayerDataExchange

The official URL for this implementation guide is: 

http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)

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<extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="template-html"/> </extension> <extension url="value"> <valueString value="template-page.html"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="template-md"/> </extension> <extension url="value"> <valueString value="template-page-md.html"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="apply-context"/> </extension> <extension url="value"> <valueString value="true"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="apply-copyright"/> </extension> <extension url="value"> <valueString value="true"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="apply-license"/> </extension> <extension url="value"> <valueString value="true"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="apply-wg"/> </extension> <extension url="value"> <valueString value="true"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="active-tables"/> </extension> <extension url="value"> <valueString value="true"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="fmm-definition"/> </extension> <extension url="value"> <valueString value="http://hl7.org/fhir/versions.html#maturity"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="propagate-status"/> </extension> <extension url="value"> <valueString value="true"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="excludelogbinaryformat"/> </extension> <extension url="value"> <valueString value="true"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="tabbed-snapshots"/> </extension> <extension url="value"> <valueString value="true"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="i18n-default-lang"/> </extension> <extension url="value"> <valueString value="en"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="wantGen-ttl"/> </extension> <extension url="value"> <valueString value="false"/> </extension> </extension> <extension url="http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"> <extension url="code"> <valueCode value="wantGen-ttl-html"/> </extension> <extension url="value"> <valueString value="false"/> </extension> </extension> <grouping id="capability"> <name value="Behavior: Capability Statements"/> <description value="The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements."/> </grouping> <grouping id="search"> <name value="Behavior: Search Parameters"/> <description value="These define the properties by which a RESTful server can be searched. They can also be used for sorting and including related resources."/> </grouping> <grouping id="abstract"> <name value="Structures: Abstract Profiles"/> <description value="These are profiles on resources or data types that describe patterns used by other profiles, but cannot be instantiated directly. I.e. instances can conform to profiles based on these abstract profiles, but do not declare conformance to the abstract profiles themselves."/> </grouping> <grouping id="basis"> <name value="Structures: Explanation of Benefits Basis Profiles"/> <description value="Basis profiles that define all non-financial element requirements for ExplanationOfBenefit types. These profiles are not expected to be implemented directly within the context of the consumer directed data exchange use case defined by this guide, but rather from within the context in which external guides may define (e.g. Provider Access API of PDEX)."/> </grouping> <grouping id="profiles"> <name value="Structures: Resource Profiles"/> <description value="These define constraints on FHIR resources for systems conforming to this implementation guide."/> </grouping> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/ADADentalProcedureCode"/> </reference> <name value="ADA Code on Dental Procedures and Nomenclature Value Set"/> <description value="The purpose of the CDT Code is to achieve uniformity, consistency and specificity in accurately documenting dental treatment. One use of the CDT Code is to provide for the efficient processing of dental claims, and another is to populate an Electronic Health Record. On August 17, 2000 the CDT Code was named as a HIPAA standard code set. Any claim submitted on a HIPAA standard electronic dental claim must use dental procedure codes from the version of the CDT Code in effect on the date of service. The CDT Code is also used on paper dental claims, and the ADA's paper claim form data content reflects the HIPAA electronic standard. CDT is published Annually. Versions should refect the YYYY of the release. The Council on Dental Benefit Programs (CDBP) has ADA Bylaws responsibility for CDT Code maintenance. To fulfill this obligation CDBP established its Code Maintenance Committee (CMC), a body that includes representatives from various sectors of the dental community (e.g., ADA; dental specialty organizations; third-party payers). CMC members, by their votes, determine which of the requested actions are incorporated into the CDT Code. Please see Code Maintenance Committee (CMC) page for information about the CMC's members and activities. To obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/ADAUniversalNumberingSystem"/> </reference> <name value="American Dental Association Universal Numbering Value Set"/> <description value="The American Dental Association Universal Numbering System is a tooth notation system primarily used in the United States. Teeth are numbered from the viewpoint of the dental practitioner looking into the open mouth, clockwise starting from the distalmost right maxillary teeth."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/BB-EOBOral1-nonfinancial"/> </reference> <name value="BB-EOBOral1-nonfinancial"/> <description value="EOB Oral Example 1 - Nonfinancial"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/BB-EOBOral2-nonfinancial"/> </reference> <name value="BB-EOBOral2-nonfinancial"/> <description value="EOB Oral Example 2 - Nonfinancial"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/BB-EOBPharmacy1-nonfinancial"/> </reference> <name value="BB-EOBPharmacy1-nonfinancial"/> <description value="EOB Pharmacy Example 1 - Nonfinancial"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBAdjudicationCategoryDiscriminator"/> </reference> <name value="C4BB Adjudication Category Discriminator Value Set"/> <description value="Used as the discriminator for adjudication.category and item.adjudication.category for the CARIN IG for Blue Button®"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBAdjudication"/> </reference> <name value="C4BB Adjudication Code System"/> <description value="Describes the various amount fields used when payers receive and adjudicate a claim. It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBAdjudicationDiscriminator"/> </reference> <name value="C4BB Adjudication Discriminator Code System"/> <description value="Used as the discriminator for the data elements in adjudication and item.adjudication. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBAdjudication"/> </reference> <name value="C4BB Adjudication Value Set"/> <description value="Describes the various amount fields used when payers receive and adjudicate a claim. It includes the values defined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the C4BB Adjudication CodeSystem."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBAmbulanceTransportReasonCodes"/> </reference> <name value="C4BB Ambulance Transport Reasons Value Set"/> <description value="Transportation Services Ambulatory Transport Reason Codes"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CapabilityStatement"/> </extension> <reference> <reference value="CapabilityStatement/c4bb"/> </reference> <name value="C4BB CapabilityStatement"/> <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."/> <exampleBoolean value="false"/> <groupingId value="capability"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBClaimCareTeamRole"/> </reference> <name value="C4BB Claim Care Team Role Code System"/> <description value="Describes functional roles of the care team members. Complements http://terminology.hl7.org/CodeSystem/claimcareteamrole. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBClaimDiagnosisType"/> </reference> <name value="C4BB Claim Diagnosis Type Code System"/> <description value="Indicates if the institutional diagnosis is admitting, principal, secondary, other, an external cause of injury or a patient reason for visit. Complements http://terminology.hl7.org/CodeSystem/ex-diagnosistype. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBClaimIdentifierType"/> </reference> <name value="C4BB Claim Identifier Type Value Set"/> <description value="Indicates that the claim identifier is that assigned by a payer for a claim received from a provider or subscriber"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBClaimInpatientInstitutionalDiagnosisType"/> </reference> <name value="C4BB Claim Inpatient Institutional Diagnosis Type Value Set"/> <description value="Indicates if the inpatient institutional diagnosis is admitting, principal, other or an external cause of injury."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBClaimInstitutionalCareTeamRole"/> </reference> <name value="C4BB Claim Institutional Care Team Role Value Set"/> <description value="Describes functional roles of the care team members."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBClaimOutpatientInstitutionalDiagnosisType"/> </reference> <name value="C4BB Claim Outpatient Institutional Diagnosis Type Value Set"/> <description value="Indicates if the outpatient institutional diagnosis is principal, other, an external cause of injury or a patient reason for visit."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBClaimPharmacyTeamRole"/> </reference> <name value="C4BB Claim Pharmacy CareTeam Role Value Set"/> <description value="Describes functional roles of the care team members"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBClaimProcedureType"/> </reference> <name value="C4BB Claim Procedure Type Code System"/> <description value="Indicates if the inpatient institutional procedure (ICD-PCS) is the principal procedure or another procedure. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBClaimProcedureType"/> </reference> <name value="C4BB Claim Procedure Type Value Set"/> <description value="Indicates if the inpatient institutional procedure (ICD-PCS) is the principal procedure or another procedure"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBClaimProfessionalAndNonClinicianCareTeamRole"/> </reference> <name value="C4BB Claim Professional And Non Clinician Care Team Role Value Set"/> <description value="Describes functional roles of the care team members"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBClaimProfessionalAndNonClinicianDiagnosisType"/> </reference> <name value="C4BB Claim Professional And Non Clinician Diagnosis Type Value Set"/> <description value="Indicates if the professional and non-clinician diagnosis is principal or secondary"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBCompoundLiteral"/> </reference> <name value="C4BB Compound Literal Code System"/> <description value="CodeSystem for a Literal 'compound' value. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-Coverage"/> </reference> <name value="C4BB Coverage"/> <description value="Data that reflect a payer’s coverage that was effective as of the date of service or the date of admission of the claim."/> <exampleBoolean value="false"/> <groupingId value="profiles"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource:abstract"/> </extension> <reference> <reference value="StructureDefinition/C4BB-ExplanationOfBenefit"/> </reference> <name value="C4BB Explanation Of Benefit"/> <description value="Abstract parent profile that includes constraints that are common to the four specific ExplanationOfBenefit (EOB) profiles defined in this Implementation Guide. All EOB instances should be from one of the four concrete EOB profiles defined in this Implementation Guide: Inpatient, Outpatient, Pharmacy, and Professional/NonClinician"/> <exampleBoolean value="false"/> <groupingId value="abstract"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional"/> </reference> <name value="C4BB ExplanationOfBenefit Inpatient Institutional"/> <description value="The profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for inpatient services, which may include the use of equipment and supplies, laboratory services, radiology services and other charges. Inpatient claims are submitted for services rendered at an institution as part of an overnight stay. The claims data is based on the institutional claim format UB-04, submission standards adopted by the Department of Health and Human Services. The profile has requirements for financial data."/> <exampleBoolean value="false"/> <groupingId value="profiles"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional-Basis"/> </reference> <name value="C4BB ExplanationOfBenefit Inpatient Institutional Basis"/> <description value="The basis profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for inpatient services, which may include the use of equipment and supplies, laboratory services, radiology services and other charges. Inpatient claims are submitted for services rendered at an institution as part of an overnight stay. The claims data is based on the institutional claim format UB-04, submission standards adopted by the Department of Health and Human Services. The basis profile does not have requirements for financial data."/> <exampleBoolean value="false"/> <groupingId value="basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-ExplanationOfBenefit-Oral"/> </reference> <name value="C4BB ExplanationOfBenefit Oral"/> <description value="This profile is used for Explanation of Benefits (EOBs) based on claims submitted by providers of oral services including Dental, Denture and Hygiene. The ADA Dental Claim Form provides a common format for reporting dental services to a patient's dental benefit plan. The profile has requirements for financial data."/> <exampleBoolean value="false"/> <groupingId value="profiles"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis"/> </reference> <name value="C4BB ExplanationOfBenefit Oral Basis"/> <description value="This profile is used for Explanation of Benefits (EOBs) based on claims submitted by providers of oral services including Dental, Denture and Hygiene. The ADA Dental Claim Form provides a common format for reporting dental services to a patient's dental benefit plan. The basis profile does not have requirements for financial data."/> <exampleBoolean value="false"/> <groupingId value="basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"/> </reference> <name value="C4BB ExplanationOfBenefit Outpatient Institutional"/> <description value="This profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for outpatient services, which may include including the use of equipment and supplies, laboratory services, radiology services and other charges. Outpatient claims are submitted for services rendered at an institution that are not part of an overnight stay. The claims data is based on the institutional claim form UB-04, submission standards adopted by the Department of Health and Human Services. The profile has requirements for financial data."/> <exampleBoolean value="false"/> <groupingId value="profiles"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis"/> </reference> <name value="C4BB ExplanationOfBenefit Outpatient Institutional Basis"/> <description value="This profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for outpatient services, which may include including the use of equipment and supplies, laboratory services, radiology services and other charges. Outpatient claims are submitted for services rendered at an institution that are not part of an overnight stay. The claims data is based on the institutional claim form UB-04, submission standards adopted by the Department of Health and Human Services. The basis profile does not have requirements for financial data."/> <exampleBoolean value="false"/> <groupingId value="basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy"/> </reference> <name value="C4BB ExplanationOfBenefit Pharmacy"/> <description value="This profile is used for Explanation of Benefits (EOBs) based on claims submitted by retail pharmacies. The claims data is based on submission standards adopted by the Department of Health and Human Services defined by NCPDP (National Council for Prescription Drug Program) The profile has requirements for financial data."/> <exampleBoolean value="false"/> <groupingId value="profiles"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis"/> </reference> <name value="C4BB ExplanationOfBenefit Pharmacy Basis"/> <description value="This profile is used for Explanation of Benefits (EOBs) based on claims submitted by retail pharmacies. The claims data is based on submission standards adopted by the Department of Health and Human Services defined by NCPDP (National Council for Prescription Drug Program) The basis profile does not have requirements for financial data."/> <exampleBoolean value="false"/> <groupingId value="basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"/> </reference> <name value="C4BB ExplanationOfBenefit Professional NonClinician"/> <description value="This profile is used for Explanation of Benefits (EOBs) based on claims submitted by physicians, suppliers and other non-institutional providers for professional and vision services. These services may be rendered in inpatient or outpatient, including office locations. The claims data is based on the professional claim form 1500, submission standards adopted by the Department of Health and Human Services as form CMS-1500. The profile has requirements for financial data."/> <exampleBoolean value="false"/> <groupingId value="profiles"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician-Basis"/> </reference> <name value="C4BB ExplanationOfBenefit Professional NonClinician Basis"/> <description value="This profile is used for Explanation of Benefits (EOBs) based on claims submitted by physicians, suppliers and other non-institutional providers for professional and vision services. These services may be rendered in inpatient or outpatient, including office locations. The claims data is based on the professional claim form 1500, submission standards adopted by the Department of Health and Human Services as form CMS-1500. The basis profile does not have requirements for financial data."/> <exampleBoolean value="false"/> <groupingId value="basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBIdentifierType"/> </reference> <name value="C4BB Identifier Type Code System"/> <description value="Identifier Type codes that extend those defined in http://terminology.hl7.org/CodeSystem/v2-0203 to define the type of identifier payers and providers assign to claims and patients. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBInstitutionalClaimSubType"/> </reference> <name value="C4BB Institutional Claim SubType Code System"/> <description value="Indicates if institutional ExplanationOfBenefit is inpatient or outpatient. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBInstitutionalClaimSubType"/> </reference> <name value="C4BB Institutional Claim SubType Value Set"/> <description value="Indicates if institutional ExplanationOfBenefit is inpatient or outpatient."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-Organization"/> </reference> <name value="C4BB Organization"/> <description value="This profile builds upon the US Core Organization profile. It is used to convey a payer, provider, payee or service facility organization."/> <exampleBoolean value="false"/> <groupingId value="profiles"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBOrganizationIdentifierType"/> </reference> <name value="C4BB Organization Identifier Type Value Set"/> <description value="Identifies the type of identifiers for organizations"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-Patient"/> </reference> <name value="C4BB Patient"/> <description value="This profile builds upon the US Core Patient profile. It is used to convey information about the patient who received the services described on the claim."/> <exampleBoolean value="false"/> <groupingId value="profiles"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBPatientIdentifierType"/> </reference> <name value="C4BB Patient Identifier Type Value Set"/> <description value="Identifies the type of identifier payers and providers assign to patients"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBPayeeType"/> </reference> <name value="C4BB Payee Type Code System"/> <description value="Indicates that a payee type may be a beneficiary. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBPayeeType"/> </reference> <name value="C4BB Payee Type Value Set"/> <description value="Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBPayerAdjudicationStatus"/> </reference> <name value="C4BB Payer Adjudication Status Code System"/> <description value="Describes the various status fields used when payers adjudicate a claim, such as whether the claim was adjudicated in or out of network, if the provider was in or not in network for the service. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBPayerBenefitPaymentStatus"/> </reference> <name value="C4BB Payer Benefit Payment Status Value Set"/> <description value="Indicates the in network or out of network payment status of the claim."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBPayerClaimPaymentStatusCode"/> </reference> <name value="C4BB Payer Claim Payment Status Code Value Set"/> <description value="Indicates whether the claim / item was paid or denied."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBPayerProviderNetworkStatus"/> </reference> <name value="C4BB Payer Provider Network Status Value Set"/> <description value="Indicates the provider network status in relation to a patient's coverage as of the effective date of service or admission."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-Practitioner"/> </reference> <name value="C4BB Practitioner"/> <description value="This profile builds upon the US Core Practitioner profile. It is used to convey information about the practitioner who provided to the patient services described on the claim."/> <exampleBoolean value="false"/> <groupingId value="profiles"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBPractitionerIdentifierType"/> </reference> <name value="C4BB Practitioner Identifier Type Value Set"/> <description value="Identifies the type of identifiers for practitioners"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBProfessionalAndNonClinicianClaimSubType"/> </reference> <name value="C4BB Professional And Non Clinician Claim SubType Value Set"/> <description value="This value set includes Professional and Non Clinician Claim SubType codes."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBProfessionalAndNonClinicianClaimType"/> </reference> <name value="C4BB Professional And Non Clinician Claim Type Value Set"/> <description value="This value set includes Professional and Non Clinician Claim Type codes."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBRelatedClaimRelationshipCodes"/> </reference> <name value="C4BB Related Claim Relationship Code System"/> <description value="Identifies if the current claim represents a claim that has been adjusted and was given a prior claim number or if the current claim has been adjusted; i.e., replaced by or merged to another claim number. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBRelatedClaimRelationshipCodes"/> </reference> <name value="C4BB Related Claim Relationship Codes Value Set"/> <description value="Identifies if the current claim represents a claim that has been adjusted and was given a prior claim number or if the current claim has been adjusted; i.e., replaced by or merged to another claim number."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="StructureDefinition:resource"/> </extension> <reference> <reference value="StructureDefinition/C4BB-RelatedPerson"/> </reference> <name value="C4BB RelatedPerson"/> <description value="This profile is used to convey basic demographic information about a person related to the claim."/> <exampleBoolean value="false"/> <groupingId value="profiles"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="CodeSystem"/> </extension> <reference> <reference value="CodeSystem/C4BBSupportingInfoType"/> </reference> <name value="C4BB Supporting Info Type Code System"/> <description value="Claim Information Category - Used as the discriminator for supportingInfo. This is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBSupportingInfoType"/> </reference> <name value="C4BB SupportingInfo Type Value Set"/> <description value="Used as the discriminator for the types of supporting information for the CARIN IG for Blue Button� Implementation Guide."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBTotalCategoryDiscriminator"/> </reference> <name value="C4BB Total Category Discriminator Value Set"/> <description value="Used as the discriminator for total.category for the CARIN IG for Blue Button®"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBTransportationServiceCategories"/> </reference> <name value="C4BB Transportation Services Categories Value Set"/> <description value="Transportation Services Supporting Info Category Codes"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/CMSPlaceofServiceCodes"/> </reference> <name value="CMS Place of Service Codes (POS) Value Set"/> <description value="Place of Service Codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintain POS codes used throughout the health care industry. This code set is required for use in the implementation guide adopted as the national standard for electronic transmission of professional health care claims under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA directed the Secretary of HHS to adopt national standards for electronic transactions. These standard transactions require all health plans and providers to use standard code sets to populate data elements in each transaction. The Transaction and Code Set Rule adopted the ASC X12N-837 Health Care Claim: Professional, volumes 1 and 2, as the standard for electronic submission of professional claims. This standard names the POS code set currently maintained by CMS as the code set to be used for describing sites of service in such claims. POS information is often needed to determine the acceptability of direct billing of Medicare, Medicaid and private insurance services provided by a given provider. Current codes can be obtained [here](https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/CMSPresentOnAdmissionIndicator"/> </reference> <name value="CMS Present On Admission Indicator Codes Value Set"/> <description value="This code system consists of Present on Admission (POA) indicators which are assigned to the principal and secondary diagnoses (as defined in Section II of the Official Guidelines for Coding and Reporting) and the external cause of injury codes to indicate the presence or absence of the diagnosis at the time of inpatient admission."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Coverage"/> </extension> <reference> <reference value="Coverage/Coverage1"/> </reference> <name value="Coverage Example 1"/> <description value="Coverage Example1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Coverage"/> </extension> <reference> <reference value="Coverage/Coverage2"/> </reference> <name value="Coverage Example 2"/> <description value="Coverage Example 2"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Coverage"/> </extension> <reference> <reference value="Coverage/Coverage3"/> </reference> <name value="Coverage Example 3"/> <description value="Coverage Example 3"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/coverage-payor"/> </reference> <name value="Coverage_Payor"/> <description value="The identity of the insurer or party paying for services"/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Coverage"/> </extension> <reference> <reference value="Coverage/CoverageDental1"/> </reference> <name value="Dental Coverage Example1"/> <description value="Dental Coverage Example1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/DentalPayer1"/> </reference> <name value="Dental Payer1"/> <description value="Dental Payer1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Practitioner"/> </extension> <reference> <reference value="Practitioner/PractitionerDentalProvider1"/> </reference> <name value="Dental Provider 1"/> <description value="Dental Provider 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/CDCICD910CMDiagnosisCodes"/> </reference> <name value="Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set"/> <description value="The Value Set is a combination of values from volume 1 and volume 2 from the Code System International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and values in the Code System International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is based on the World Health Organization’s Ninth Revision, International Classification of Diseases (ICD-9). ICD-9-CM was the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States. The ICD-9-CM consists of: * a tabular list containing a numerical list of the disease code numbers in tabular form; * an alphabetical index to the disease entries; and * a classification system for surgical, diagnostic, and therapeutic procedures (alphabetic index and tabular list). The National Center for Health Statistics (NCHS) and the [Centers for Medicare and Medicaid Services](http://www.cms.hhs.gov/) are the U.S. governmental agencies responsible for overseeing all changes and modifications to the ICD-9-CM. [ICD-10-CM](https://confluence.hl7.org/pages/viewpage.action?pageId=97453674) is the replacement for ICD-9-CM, volumes 1 and 2, effective October 1, 2015. The National Center for Health Statistics (NCHS), the Federal agency responsible for use of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) in the United States, has developed a clinical modification of the classification for morbidity purposes. The ICD-10 is used to code and classify mortality data from death certificates, having replaced ICD-9 for this purpose as of January 1, 1999. The clinical modification represents a significant improvement over ICD-9-CM and ICD-10. Specific improvements include: the addition of information relevant to ambulatory and managed care encounters; expanded injury codes; the creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition; the addition of sixth and seventh characters; incorporation of common 4th and 5th digit subclassifications; laterality; and greater specificity in code assignment. The new structure will allow further expansion than was possible with ICD-9-CM. Current and previous releases of ICD-9-CM are available here: [https://www.cdc.gov/nchs/icd/icd9cm.htm](https://www.cdc.gov/nchs/icd/icd9cm.htm) Current and previous releases of ICD-10-CM are available in PDF and XML format here: [https://www.cdc.gov/nchs/icd/icd10cm.htm](https://www.cdc.gov/nchs/icd/icd10cm.htm) Most files are provided in compressed zip format for ease in downloading. These files have been created by the National Center for Health Statistics (NCHS), under authorization by the World Health Organization. Any questions regarding typographical or other errors noted on this release may be reported to nchsicd10cm@cdc.gov. When using ICD-10-CM codes, only non-header codes shoul be used. Header codes are non-billable organizational categories and should not be used for coding actual patient diagnoses."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/EOBInpatient2"/> </reference> <name value="EOB Inpatient Example 2"/> <description value="EOB Inpatient Example 2"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/EOBInpatient1"/> </reference> <name value="EOB Inpatient Example1"/> <description value="EOB Inpatient Example 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/BB-EOBInpatient1-nonfinancial"/> </reference> <name value="EOB Inpatient Institutional - Example 1 - Nonfinancial"/> <description value="EOB Inpatient Institutional - Example 1 - Nonfinancial"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional-Basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/BB-EOBInpatient2-nonfinancial"/> </reference> <name value="EOB Inpatient Institutional - Example 2 - Nonfinancial"/> <description value="EOB Inpatient Institutional - Example 2 - Nonfinancial"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional-Basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/EOBOral1"/> </reference> <name value="EOB Oral Example 1"/> <description value="EOB Oral Example 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/EOBOral2"/> </reference> <name value="EOB Oral Example 2"/> <description value="EOB Oral Example 2"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/EOBOutpatient1"/> </reference> <name value="EOB Outpatient Institutional - Example 1"/> <description value="EOB Outpatient Institutional - Example 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/BB-EOBOutpatient1-nonfinancial"/> </reference> <name value="EOB Outpatient Institutional - Example 1 - Nonfinancial"/> <description value="EOB Outpatient Institutional - Example 1 - Nonfinancial"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/EOBOutpatient2"/> </reference> <name value="EOB Outpatient Institutional - Example 2"/> <description value="EOB Outpatient Institutional - Example 2"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/BB-EOBOutpatient2-nonfinancial"/> </reference> <name value="EOB Outpatient Institutional - Example 2 - Nonfinancial"/> <description value="EOB Outpatient Institutional - Example 2 - Nonfinancial"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/EOBPharmacy1"/> </reference> <name value="EOB Pharmacy Example1"/> <description value="EOB Pharmacy Example1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/EOBProfessional1"/> </reference> <name value="EOB Professional - Example 1"/> <description value="EOB Professional - Example 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/BB-EOBProfessional1-nonfinancial"/> </reference> <name value="EOB Professional - Example 1 - Nonfinancial"/> <description value="EOB Professional Example 1 - Nonfinancial"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician-Basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/EOBProfessional2"/> </reference> <name value="EOB Professional - Example 2"/> <description value="EOB Professional - Example 2"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/BB-EOBProfessional2-nonfinancial"/> </reference> <name value="EOB Professional - Example 2 - Nonfinancial"/> <description value="EOB Professional - Example 2 - Nonfinancial"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician-Basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/EOBProfessionalTransportation1"/> </reference> <name value="EOB Professional - Transportation 1"/> <description value="EOB Professional - Transportation 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ExplanationOfBenefit"/> </extension> <reference> <reference value="ExplanationOfBenefit/BB-EOBProfessionalTransportation1-nonfinancial"/> </reference> <name value="EOB Professional - Transportation 1 - Nonfinancial"/> <description value="EOB Professional - Transportation Services Example 1 - Nonfinancial"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician-Basis"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/explanationofbenefit-billable-period-start"/> </reference> <name value="ExplanationOfBenefit_BillablePeriodStart"/> <description value="Starting Date of the service for the EOB using billablePeriod.period.start. The billable-period-start search parameter using the billablePeriod.period.start provides results with the earliest billablePeriod.start from a professional and non-clinician EOB or an oral EOB."/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/explanationofbenefit-care-team"/> </reference> <name value="ExplanationOfBenefit_Careteam"/> <description value="Member of the CareTeam"/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/explanationofbenefit-coverage"/> </reference> <name value="ExplanationOfBenefit_Coverage"/> <description value="The plan under which the claim was adjudicated"/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/explanationofbenefit-identifier"/> </reference> <name value="ExplanationOfBenefit_Identifier"/> <description value="The business/claim identifier of the Explanation of Benefit"/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/explanationofbenefit-insurer"/> </reference> <name value="ExplanationOfBenefit_Insurer"/> <description value="The party responsible for the claim"/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/practitionerrole-organization"/> </reference> <name value="ExplanationOfBenefit_Organization"/> <description value="The identity of the organization the practitioner represents / acts on behalf of"/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/explanationofbenefit-patient"/> </reference> <name value="ExplanationOfBenefit_Patient"/> <description value="The reference to the patient"/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/practitionerrole-practitioner"/> </reference> <name value="ExplanationOfBenefit_Practitioner"/> <description value="Practitioner that is able to provide the defined services for the organization"/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/explanationofbenefit-provider"/> </reference> <name value="ExplanationOfBenefit_Provider"/> <description value="The reference to the provider"/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/explanationofbenefit-service-date"/> </reference> <name value="ExplanationOfBenefit_ServiceDate"/> <description value="The service-date search parameter is meant to simplify the search for the client enabling them to use one search parameter across EoB types for the service date. With this parameter. the client doesn't need to know that for inpatient and outpatient institutional EOB dates they need to search by billablePeriod, for a pharmacy EOB by item.servicedDate, for a professional and non-clinician EOB - by item.servicedPeriod and for an oral EOB – by item.servicedPeriod."/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/explanationofbenefit-service-start-date"/> </reference> <name value="ExplanationOfBenefit_ServiceStartDate"/> <description value="Starting Date of the service for the EOB. The service-start-date search parameter simplifies search, since a client doesn't need to know that for inpatient and outpatient institutional EOB dates they need to search by billablePeriod.start, for a pharmacy EOB by item.servicedDate, for a professional and non-clinician EOB - by item.servicedPeriod.start and for an oral EOB – by item.servicedPeriod.start."/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="SearchParameter"/> </extension> <reference> <reference value="SearchParameter/explanationofbenefit-type"/> </reference> <name value="ExplanationOfBenefit_Type"/> <description value="The type of the ExplanationOfBenefit"/> <exampleBoolean value="false"/> <groupingId value="search"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/CMSMS3MAPAPRDRG"/> </reference> <name value="MS-DRGs - AP-DRGs - APR-DRGs Value Set"/> <description value="This value set defines three sets of DRGs, MS-DRGs (Medicare Severity Diagnosis Related Groups), APR-DRGs (All Patient Refined Diagnosis Related Groups) and AP-DRGs (All Patient Diagnosis Related Groups). Identifying a DRG code requires a version. **MS-DRGs** Section 1886(d) of the Act specifies that the Secretary shall establish a classification system (referred to as DRGs) for inpatient discharges and adjust payments under the IPPS based on appropriate weighting factors assigned to each DRG. Therefore, under the IPPS, we[CMS] pay for inpatient hospital services on a rate per discharge basis that varies according to the DRG to which a beneficiary's stay is assigned. The formula used to calculate payment for a specific case multiplies an individual hospital's payment rate per case by the weight of the DRG to which the case is assigned. Each DRG weight represents the average resources required to care for cases in that particular DRG, relative to the average resources used to treat cases in all DRGs. Congress recognized that it would be necessary to recalculate the DRG relative weights periodically to account for changes in resource consumption. Accordingly, section 1886(d)(4)(C) of the Act requires that the Secretary adjust the DRG classifications and relative weights at least annually. These adjustments are made to reflect changes in treatment patterns, technology, and any other factors that may change the relative use of hospital resources. Currently, cases are classified into Medicare Severity Diagnosis Related Groups (MS-DRGs) for payment under the IPPS based on the following information reported by the hospital: the principal diagnosis, up to 25 additional diagnoses, and up to 25 procedures performed during the stay. In a small number of MS-DRGs, classification is also based on the age, sex, and discharge status of the patient. Effective October 1, 2015, the diagnosis and procedure information is reported by the hospital using codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). Content can be obtained on the CMS hosted page located [here](https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software) **APR-DRGs** 3M APR DRGs have become the standard across the U.S. for classifying hospital inpatients in non-Medicare populations. As of January 2019, 27 state Medicaid programs use 3M APR DRGs to pay hospitals, as do approximately a dozen commercial payers and Medicaid managed care organizations. Over 2,400 hospitals have licensed 3M APR DRGs to verify payment and analyze their internal operations. The 3M APR DRG methodology classifies hospital inpatients according to their reason for admission, severity of illness and risk of mortality. Each year 3M calculates and releases a set of statistics for each 3M APR DRG based on our analysis of large national data sets. These statistics include a relative weight for each 3M APR DRG. The relative weight reflects the average hospital resource use for a patient in that 3M APR DRG relative to the average hospital resource use of all inpatients. Please note that payers and other users of the 3M APR DRG methodology are responsible for ensuring that they use relative weights that are appropriate for their particular populations. The 3M APR DRG statistics also include data for each 3M APR DRG on relative frequency, average length of stay, average charges and incidence of mortality. 3M APR DRGs can be rolled up into broader categories. The 326 base DRGs roll up into 25 major diagnostic categories (MDCs) plus a pre-MDC category. An example is MDC 04, Diseases and Disorders of the Respiratory System. As well, each 3M APR DRG is assigned to a service line that is consistent with the outpatient service lines that are defined by the 3M™ Enhanced Ambulatory Patient Groups (EAPGs). Link to information about the code system - including how to obtain the content from 3M - is available [here.](https://www.3m.com/3M/en_US/health-information-systems-us/drive-value-based-care/patient-classification-methodologies/apr-drgs/). **AP-DRGs** In 1987, the state of New York passed legislation instituting a DRG-based prospective payment system for all non-Medicare patients. The legislation included a requirement that the New York State Department of Health (NYDH) evaluate the applicability of the DRGs to a non-Medicare population. In particular, the legislation required that the DRGs be evaluated with respect to neonates and patients with Human Immunodeficiency Virus (HIV) infections. NYDH entered into an agreement with 3M HIS to assist with the evaluation of the need for DRG modifications as well as to make the necessary changes in the DRG definitions and software. The DRG definitions developed by NYDH and 3M HIS are referred to as the All Patient DRGs (AP DRGs). The AP DRG code system is no longer updated as DRG classification system evolved to APR DRG. Evolution of DRG is summarized in the APR DRG methodology overview as well as in various articles. Goldfield N. The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital. Qual Manage Health Care. 2010;19(1)3-16. Averill RF, Goldfield NI, Muldoon J, Steinbeck BA, Grant TM. A closer look at All-Patient Refined DRGs. J AHIMA. 2002;73(1):46-49. [https://apps.3mhis.com/docs/Groupers/All\_Patient\_Refined\_DRG/Methodology\_overview\_GRP041/grp041\_aprdrg\_meth\_overview.pdf](https://apps.3mhis.com/docs/Groupers/All_Patient_Refined_DRG/Methodology_overview_GRP041/grp041_aprdrg_meth_overview.pdf)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/FDANationalDrugCode"/> </reference> <name value="National Drug Code (NDC) Value Set"/> <description value="The Drug Listing Act of 1972 requires registered drug establishments to provide the Food and Drug Administration (FDA) with a current list of all drugs manufactured, prepared, propagated, compounded, or processed by it for commercial distribution. (See Section 510 of the Federal Food, Drug, and Cosmetic Act (Act) (21 U.S.C. § 360)). Drug products are identified and reported using a unique, three-segment number, called the National Drug Code (NDC), which serves as a universal product identifier for drugs. FDA publishes the listed NDC numbers and the information submitted as part of the listing information in the NDC Directory which is updated daily. The information submitted as part of the listing process, the NDC number, and the NDC Directory are used in the implementation and enforcement of the Act. Users should note: Starting June 1, 2011, only drugs for which electronic listings (SPL) have been submitted to FDA are included in the NDC Directory. Drugs for which listing information was last submitted to FDA on paper forms, prior to June 2009, are included on a separate file and will not be updated after June 2012. Information regarding the FDA published NDC Directory can be found [here](https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory) Users should note a few important items * The NDC Directory is updated daily. * The new NDC Directory contains ONLY information on final marketed drugs submitted to FDA in SPL electronic listing files by labelers. * The NDC Directory does not contain all listed drugs. The new version includes the final marketed drugs which listing information were submitted electronically. It does not include animal drugs, blood products, or human drugs that are not in final marketed form, such as Active Pharmaceutical Ingredients(APIs), drugs for further processing, drugs manufactured exclusively for a private label distributor, or drugs that are marketed solely as part of a kit or combination product or inner layer of a multi-level packaged product not marketed individually. For more information about how certain kits or multi-level packaged drugs are addressed in the new NDC Directory, see the NDC Directory Package File definitions document. For the FDA Online Label Repository page and additional resources go to: [FDA Online Label Repository](https://labels.fda.gov/)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/NCPDPBrandGenericIndicator"/> </reference> <name value="NCPDP Brand Generic Indicator Value Set"/> <description value="Denotes brand or generic drug dispensed. (NCPDP ECL 686) Link to information about the code system - including how to obtain the content: [https://standards.ncpdp.org/Access-to-Standards.aspx](https://standards.ncpdp.org/Access-to-Standards.aspx)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/NCPDPCompoundCode"/> </reference> <name value="NCPDP Compound Code Value Set"/> <description value="Code indicating whether or not the prescription is a compound. (NCPDP ECL 406-D6) Link to information about the code system - including how to obtain the content: [https://standards.ncpdp.org/Access-to-Standards.aspx](https://standards.ncpdp.org/Access-to-Standards.aspx)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/NCPDPDispensedAsWrittenOrProductSelectionCode"/> </reference> <name value="NCPDP Dispense As Written (DAW)/Product Selection Code Value Set"/> <description value="Code indicating whether or not the prescriber's instructions regarding generic substitution were followed. (NCPDP ECL 408-D8) Link to information about the code system - including how to obtain the content: [https://standards.ncpdp.org/Access-to-Standards.aspx](https://standards.ncpdp.org/Access-to-Standards.aspx)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/NCPDPPrescriptionOriginCode"/> </reference> <name value="NCPDP Prescription Origin Code Value Set"/> <description value="Code indicating the origin of the prescription. Indicates whether the prescription was transmitted as an electronic prescription, by phone, by fax, or as a written paper copy. (NCPDP ECL 419-DJ) Link to information about the code system - including how to obtain the content: [https://standards.ncpdp.org/Access-to-Standards.aspx](https://standards.ncpdp.org/Access-to-Standards.aspx)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/NCPDPRejectCode"/> </reference> <name value="NCPDP Reject Code Value Set"/> <description value="Code indicating the error encountered. Contains exception definitions for use when transaction processing cannot be completed. (NCPDP ECL 511-FB). Link to information about the code system - including how to obtain the content: [https://standards.ncpdp.org/Access-to-Standards.aspx](https://standards.ncpdp.org/Access-to-Standards.aspx)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/FDANDCOrCompound"/> </reference> <name value="NDC or Compound Value Set"/> <description value="Values will be the NDC Codes when the Compound Code value is 0 or 1. When the Compound Code value = 2, the value will be the literal, ‘compound’"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/AHANUBCPatientDischargeStatus"/> </reference> <name value="NUBC Patient Discharge Status Codes Value Set"/> <description value="The UB-04 Data File contains the complete set of NUBC codes. Every code in the range of possible codes is accounted for sequentially. There are no gaps because all used and unused codes are identified. This code system consists of the following: * FL 17 - Patient Discharge Status These codes are used to convey the patient discharge status and are the property of the American Hospital Association. To obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/AHANUBCPointOfOriginForAdmissionOrVisit"/> </reference> <name value="NUBC Point Of Origin Value Set"/> <description value="The UB-04 Data File contains the complete set of NUBC codes. Every code in the range of possible codes is accounted for sequentially. There are no gaps because all used and unused codes are identified. This code system consists of the following: * FL 15 - Point of Origin for Admission or Visit These codes are used to convey the patient point of origin for an admission or visit and are the property of the American Hospital Association To obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/AHANUBCPriorityTypeOfAdmissionOrVisit"/> </reference> <name value="NUBC Priority (Type) of Admission or Visit Value Set"/> <description value="The UB-04 Data File contains the complete set of NUBC codes. Every code in the range of possible codes is accounted for sequentially. There are no gaps because all used and unused codes are identified. This code system consists of the following: * FL 14 - Priority (Type) of Admission or Visit These codes are used to convey the priority of an admission or visit and are the property of the American Hospital Association. To obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/AHANUBCRevenueCodes"/> </reference> <name value="NUBC Revenue Codes Value Set"/> <description value="The UB-04 Data File contains the complete set of NUBC codes. Every code in the range of possible codes is accounted for sequentially. There are no gaps because all used and unused codes are identified. This code system consists of the following: * FL 42 - Revenue Codes These codes are used to convey the revenue code and are the property of the American Hospital Association. To obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/AHANUBCTypeOfBill"/> </reference> <name value="NUBC Type of Bill Codes Value Set"/> <description value="The UB-04 Data File contains the complete set of NUBC codes. Every code in the range of possible codes is accounted for sequentially. There are no gaps because all used and unused codes are identified. This code system consists of the following: * FL 04 - Type of Bill Facility Codes * FL 04 - Type of Bill Frequency Codes A code indicating the specific Type of Bill (TOB), e.g., hospital inpatient, outpatient, replacements, voids, etc. The first digit is a leading zero\*. The fourth digit defines the frequency of the bill for the institutional and electronic professional claim. Note that with the advent of UB-04, the matrix methodology of constructing the first component of TOB codes according to digit position was abandoned in favor of specifying valid discrete codes. As a result, the first three digits in TOB have no underlying meaning. To obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)"/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/OralBodySite"/> </reference> <name value="Oral Body Site Value Set"/> <description value="Oral Body Site indicating tooth numbers and area of oral cavity."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Patient"/> </extension> <reference> <reference value="Patient/Patient1"/> </reference> <name value="Patient Example 1"/> <description value="Patient Example 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Patient"/> </extension> <reference> <reference value="Patient/Patient2"/> </reference> <name value="Patient Example 2"/> <description value="Patient Example 2"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/Payer1"/> </reference> <name value="Payer 1"/> <description value="Payer 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/Payer2"/> </reference> <name value="Payer 2"/> <description value="Payer 2"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Practitioner"/> </extension> <reference> <reference value="Practitioner/Practitioner1"/> </reference> <name value="Practitioner Example 1"/> <description value="Practitioner Example 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Practitioner"/> </extension> <reference> <reference value="Practitioner/Practitioner2"/> </reference> <name value="Practitioner Example 2"/> <description value="Practitioner Example 2"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Practitioner"/> </extension> <reference> <reference value="Practitioner/Practitioner3"/> </reference> <name value="Practitioner Example 3"/> <description value="Practitioner Example 3"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Practitioner"/> </extension> <reference> <reference value="Practitioner/Practitioner4"/> </reference> <name value="Practitioner4"/> <description value="Practitioner 4"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBEOBInstitutionalProcedureCodes"/> </reference> <name value="Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set"/> <description value="The Value Set is a combination of three Code Systems: CPT (HCPCS I), HCPCS II procedure codes, and HIPPS rate codes. They are submitted by providers to payers to convey the specific procedure performed. Procedure Codes leverage US Core Procedure Codes composition. The target set for this value set are the procedure codes from the CPT and HCPCS files and the rate codes from the HIPPS files. The Current Procedural Terminology (CPT) code set, created and maintained by the American Medical Association, is the language of medicine today and the code to its future. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT coding is also used for administrative management purposes such as claims processing and developing guidelines for medical care review. Each year, via a rigorous, evidence-based and transparent process, the independent CPT Editorial Panel revises, creates or deletes hundreds of codes in order to reflect current medical practice. Designated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services. All CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm. There are various types of CPT codes: **Category I:** These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy. **Category II:** These alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding. **Category III:** These are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code. **Proprietary Laboratory Analyses (PLA) codes:** Recently added to the CPT code set, these codes describe proprietary clinical laboratory analyses and can be either provided by a single (solesource) laboratory or licensed or marketed to multiple providing laboratories that are cleared or approved by the Food and Drug Administration (FDA)). This category includes but is not limited to Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA). To obtain CPT, please see the license request form [here](http://info.commerce.ama-assn.org/ama-data-file-request-2020) The Level II HCPCS codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4 (CPT-4) codes; Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing. Level II alphanumeric procedure and modifier codes comprise the A to V range. General information can be found here: [https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo](https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo) Releases can be found here: [https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets](https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets) These files contain the Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage and pricing data. The Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets of patient characteristics (or case-mix groups) health insurers use to make payment determinations under several prospective payment systems. Case-mix groups are developed based on research into utilization patterns among various provider types. For the payment systems that use HIPPS codes, clinical assessment data is the basic input. A standard patient assessment instrument is interpreted by case-mix grouping software algorithms, which assign the case mix group. For payment purposes, at least one HIPPS code is defined to represent each case-mix group. These HIPPS codes are reported on claims to insurers. Institutional providers use HIPPS codes on claims in association with special revenue codes. One revenue code is defined for each prospective payment system that requires HIPPS codes. HIPPS codes are placed in data element SV202 on the electronic 837 institutional claims transaction, using an HP qualifier, or in Form Locator (FL) 44 ("HCPCS/rate") on a paper UB-04 claims form. The associated revenue code is placed in data element SV201 or in FL 42. In certain circumstances, multiple HIPPS codes may appear on separate lines of a single claim. HIPPS codes are alpha-numeric codes of five digits. Each code contains intelligence, with certain positions of the code indicating the case mix group itself, and other positions providing additional information. The additional information varies among HIPPS codes pertaining to different payment systems, but often provides information about the clinical assessment used to arrive at the code. Which positions of the code carry the case mix group information may also vary by payment systems."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/AMACPTCMSHCPCSProcedureCodes"/> </reference> <name value="Procedure Codes - AMA CPT - CMS HCPCS Value Set"/> <description value="The Value Set is a combination of two Code Systems: CPT (HCPCS I) and HCPCS II procedure codes. They are submitted by providers to payers to convey the specific procedure performed. Procedure Codes leverage US Core Procedure Codes composition. The target set for this value set are the procedure codes from the CPT and HCPCS files. The Current Procedural Terminology (CPT) code set, created and maintained by the American Medical Association, is the language of medicine today and the code to its future. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT coding is also used for administrative management purposes such as claims processing and developing guidelines for medical care review. Each year, via a rigorous, evidence-based and transparent process, the independent CPT Editorial Panel revises, creates or deletes hundreds of codes in order to reflect current medical practice. Designated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services. All CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm. There are various types of CPT codes: **Category I:** These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy. **Category II:** These alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding. **Category III:** These are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code. **Proprietary Laboratory Analyses (PLA) codes:** Recently added to the CPT code set, these codes describe proprietary clinical laboratory analyses and can be either provided by a single (solesource) laboratory or licensed or marketed to multiple providing laboratories that are cleared or approved by the Food and Drug Administration (FDA)). This category includes but is not limited to Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA). To obtain CPT, please see the license request form [here](http://info.commerce.ama-assn.org/ama-data-file-request-2020) The Level II HCPCS codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4 (CPT-4) codes; Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing. Level II alphanumeric procedure and modifier codes comprise the A to V range. General information can be found here: [https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo](https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo) Releases can be found here: [https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets](https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets) These files contain the Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage and pricing data."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/CMSICD910PCSProcedureCodes"/> </reference> <name value="Procedure Codes - International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - ICD-10 Procedure Value Set"/> <description value="The Value Set is a combination of values from volume 3 from the Code System International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and values in the Code System ICD-10 Procedure Coding System. The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is based on the World Health Organization’s Ninth Revision, International Classification of Diseases (ICD-9). ICD-9-CM was the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States. The ICD-9-CM consists of: * a tabular list containing a numerical list of the disease code numbers in tabular form; * an alphabetical index to the disease entries; and * a classification system for surgical, diagnostic, and therapeutic procedures (alphabetic index and tabular list). The National Center for Health Statistics (NCHS) and the [Centers for Medicare and Medicaid Services](http://www.cms.hhs.gov/) are the U.S. governmental agencies responsible for overseeing all changes and modifications to the ICD-9-CM. The ICD-10-PCS is the replacement for ICD-9-CM, volume 3, effective October 1, 2015. The ICD-10-PCS is a procedure classification published by the United States Centers for Medicare & Medicaid Services (CMS) ([https://www.cms.gov](https://www.cms.gov/)) for classifying procedures performed in hospital inpatient health care settings. Current and previous releases of ICD-9-CM are available here: [https://www.cdc.gov/nchs/icd/icd9cm.htm](https://www.cdc.gov/nchs/icd/icd9cm.htm) Most files are provided in compressed zip format for ease in downloading. These files have been created by the National Center for Health Statistics (NCHS), under authorization by the World Health Organization. Any questions regarding typographical or other errors noted on this release may be reported to [nchsicd10cm@cdc.gov](mailto:nchsicd10cm@cdc.gov). A link to information about the ICD-10-PCS code system - including how to obtain the content - is available at [https://www.cms.gov/Medicare/Coding/ICD10.](https://www.cms.gov/Medicare/Coding/ICD10) Note: CMS is the owner of the ICD-10-PCS code system. CMS is NOT the owner of ICD-10-CM. CMS republishes the ICD-10-CM codes system on their website for convenience only. For authoritative information on ICD-10-CM, users should refer to the National Center for Health Statistics (NCHS) site located [here](https://www.cdc.gov/nchs/icd/icd10cm.htm). When using ICD-10-CM codes, only non-header codes shoul be used. Header codes are non-billable organizational categories and should not be used for coding actual patient diagnoses."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/AMACPTCMSHCPCSModifiers"/> </reference> <name value="Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set"/> <description value="The Value Set is a combination of two Code Systems: CPT (HCPCS I) and HCPCS II procedure code modifiers. Modifiers help further describe a procedure code without changing its definition. The target set for this value set are the procedure code modifiers from the CPT and HCPCS files. The Current Procedural Terminology (CPT) code set, created and maintained by the American Medical Association, is the language of medicine today and the code to its future. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT coding is also used for administrative management purposes such as claims processing and developing guidelines for medical care review. Each year, via a rigorous, evidence-based and transparent process, the independent CPT Editorial Panel revises, creates or deletes hundreds of codes in order to reflect current medical practice. Designated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services. All CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm. There are various types of CPT codes: **Category I:** These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy. **Category II:** These alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding. **Category III:** These are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code. **Proprietary Laboratory Analyses (PLA) codes:** Recently added to the CPT code set, these codes describe proprietary clinical laboratory analyses and can be either provided by a single (solesource) laboratory or licensed or marketed to multiple providing laboratories that are cleared or approved by the Food and Drug Administration (FDA)). This category includes but is not limited to Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA). To obtain CPT, please see the license request form [here](http://info.commerce.ama-assn.org/ama-data-file-request-2020) The Level II HCPCS codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4 (CPT-4) codes; Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing. Level II alphanumeric procedure and modifier codes comprise the A to V range. General information can be found here: [https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo](https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo) Releases can be found here: [https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets](https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets) These files contain the Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage and pricing data."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/ProviderOrganization1"/> </reference> <name value="Provider Organization 1"/> <description value="Provider Organization 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/ProviderOrganization2"/> </reference> <name value="Provider Organization 2"/> <description value="Provider Organization 2"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/ProviderOrganization3"/> </reference> <name value="Provider Organization 3"/> <description value="Provider Organization 3"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/ProviderOrganization4"/> </reference> <name value="Provider Organization 4"/> <description value="Provider Organization 4"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/ProviderOrganization5"/> </reference> <name value="Provider Organization 5"/> <description value="Provider Organization 5"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/ProviderOrganization6"/> </reference> <name value="Provider Organization 6"/> <description value="Provider Organization 6"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="Organization"/> </extension> <reference> <reference value="Organization/ProviderTransportationOrganization1"/> </reference> <name value="Provider Transportation Organization Example 1"/> <description value="Provider Transportation Organization Example 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="RelatedPerson"/> </extension> <reference> <reference value="RelatedPerson/RelatedPerson1"/> </reference> <name value="Related Person 1"/> <description value="Related Person 1"/> <exampleCanonical value="http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-RelatedPerson"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/C4BBSurfaceCodes"/> </reference> <name value="US Surface Codes Set Value Set"/> <description value="This value set includes FDI tooth surface codes localized for the US Realm."/> <exampleBoolean value="false"/> </resource> <resource> <extension url="http://hl7.org/fhir/tools/StructureDefinition/resource-information"> <valueString value="ValueSet"/> </extension> <reference> <reference value="ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes"/> </reference> <name value="X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set"/> <description value="X12, chartered by the American National Standards Institute for more than 40 years, develops and maintains EDI standards and XML schemas which drive business processes globally. X12's diverse membership includes technologists and business process experts in health care, insurance, transportation, finance, government, supply chain and other industries. The X12 Claim Adjustment Reason Codes describe why a claim or service line was paid differently than it was billed. These codes are listed within an X12 implementation guide (TR3) and maintained by X12. Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. Each RARC identifies a specific message as shown in the Remittance Advice Remark Code List. There are two types of RARCs, supplemental and informational. The majority of the RARCs are supplemental; these are generally referred to as RARCs without further distinction. Supplemental RARCs provide additional explanation for an adjustment already described by a CARC. The second type of RARC is informational; these RARCs are all prefaced with Alert: and are often referred to as Alerts. Alerts are used to convey information about remittance processing and are never related to a specific adjustment or CARC. External code lists maintained by X12 and external code lists maintained by others and distributed by WPC on behalf of the maintainer can be found here: [https://x12.org/codes](https://x12.org/codes) Click on the name of any external code list to access more information about the code list, view the codes, or submit a maintenance request. 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