CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
1.0.0 - STU1

This page is part of the CARIN Blue Button Implementation Guide (v1.0.0: STU 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions

Common Payer Consumer Data Set

The Common Payer Consumer Data Set (CPCDS) is a logical data set (similar to ONC 2015 Edition Common Clinical Data Set) that meets CMS Blue Button 2.0 API content The CPCDS data elements can be stored and queried as profiled FHIR resources. They define key payer financial health data that SHALL be accessible and available to through standards-based APIs. Data SHALL conform to specified profiles, vocabulary standards and code sets.

 

Mapping from CPCDS to FHIR Resources

Based on CPCDS, the mappings define the minimum mandatory elements, extensions and terminology requirements that must be present in the FHIR resource. Additional business rules are also specified.
Title Format Description
Profile comparison overview  ppt High level profile comparison showing header vs item data elements and value sets requiring licenses.
 Detailed Profile comparison xls A detailed comparison of the profiles defined in this IG with their base resource or profile is shown in the figures on this page.
CPCDS Data Dictionary doc Defines key health data that should be accessible and available for exchange.
CPCDS to FHIR Profiles Mapping xls Mapping Worksheet  to aid implementers in understanding the data representation requirements of each EOB Profile and the referenced resources used by these profiles.
Documentation of CPCDS to FHIR Profiles Mapping ppt Description of the layout of the Mapping Worksheet and how to use it to understand the profiled data mappings to the FHIR resources.

 

Explanation of Benefits Resource Profiles Definition

Profiles for Explanation of Benefit (EOB) and other reference resources are defined in this IG. Data elements in each of the EOB profiles aligns with US Department of Health and Human Services claims submission standards. An abstract EOB profile is defined, representing constraints found in all the EOB types. Four profiles define the data constraints for the specific claim type (i.e., inpatient institutional, outpatient institutional, professional and non-clinician and pharmacy). The profiles use many industry standard codes. The owners of those codes and an indicator for those requiring licenses is provided. A side by side comparison of the abstract EOB profile, and the four concrete profiles is shown here.
 


  A detailed comparison of the profiles defined in this IG with their base resource or profile is shown in the following two figures.

 
Additional EOB profiles for Vision and Dental benefits are planned for future versions of this IG.