CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) was developed under the CARIN Alliance.

Changes and Updates for Version 1.1.0

The current official published version of CARIN BB for FHIR R4 (STU Update of STU 1)

• Added Data Absent Reason "not-applicable" code to Institutional Procedure Codes ValueSet for use with Inpatient Institutional EOB item.productOrService and an Invariant disallowing the use of this code in Outpatient Institutional EOB (FHIR-30357)
• Changed Inpatient Institutional EOB supportingInfo DRG code terminology binding strength from required to extensible to allow for state Medicaid assigned DRGs (FHIR-30380)
• Added HIPPS codes to Institutional EOB Procedure Codes ValueSet (FHIR-30413)
• Added C4BB Payer Benefit Payment Status to C4BB Adjudication Category Discriminator ValueSet for use in the Professional and NonClinician EOB item.adjudication and removed inoutnetwork code from Adjudication Discriminator CodeSystem (FHIR-30806)
• Changes on differentiating ExplanationOfBenefit profiles (FHIR-31594)
  • Added ExplanationofBenefit.subType requirements to the Inpatient and Outpatient Institutional ExplanationOfBenefit profiles.
  • Added Institutional Claim Subtype ValueSet and Institutional Claim Subtype CodeSystem
• Changed resources used to present patient account number and medical record number (FHIR-31534)
  • Removed medrecnum and patacctnum slices from the Patient profile Patient.Identifier
  • Added medicalrecordnumber and patientaccountnumber supportingInfo slices to Inpatient, Outpatient, and Professional Non-Clinical ExplanationOfBenefit profiles
  • Added medicalrecordnumber and patientaccountnumber to Supporting Info Type CodeSystem
• Added NUBC Point of Origin for Newborn CodeSystem and renamed NUBC Point of Origin CodeSystem to NUBC Point of Origin for Non-newborn CodeSystem for Inpatient and Outpatient Institutional EOB supportingInfo Point of Origin ValueSet for use when Type of Admission is newborn, Inpatient Institutional EOB Invariant, and Outpatient Institutional EOB Invariant (FHIR-30370 and FHIR-31384)
• Added Invariants requiring adjudication[adjudicationamounttype] and adjudication[adjudicationamounttype].amount when header level adjudication is present to Inpatient and Outpatient Institutional EOBs and changed Professional and NonClinician EOB total[adjudicationamounttype] to a cardinality of 1..*( Changed item.adjudication[adjudicationamounttype].amount (FHIR-30369)
• Changes of requirements and guidance on all profiles meta.profile (FHIR-30375)
  • Defined fixed values for a slice of meta.profile for all profiles.
  • Added guidance on the use of meta.profile as notes to all profiles.
• Updated NCPDP CodeSystem URLs (FHIR-31492) including:
  • NCPDP Brand Generic Indicator
  • NCPDP Compound Code
  • NCPDP Dispense As Written (DAW)/Product Selection Code
  • NCPDP Prescription Origin Code
  • NCPDP Reject Code
• Changed inoutnetwork slice names and cardinalities (FHIR-30635)
  • Changed Inpatient Institutional, Outpatient Institutional, and Pharmacy EOBs total[inoutnetwork] slice name to benefitpaymentstatus
  • Changed Professional and NonClinician EOB item.adjudication[inoutnetwork] slice name to benefitpayementstatus
  • Changed cardinality of Inpatient and Outpatient Institutional EOB total[benefitpaymentstatus] from (0..1) to (1..1)
  • Removed notes in Professional and NonClinician EOB referencing total[inoutnetwork] slice name
  • Updated notes for all profiles that referenced inoutnetwork slice name to benefitpaymentstatus
  • Updated the Detailed Profile Comparison image and source file (xslx) in section 5
• Changed cardinality of several slice properties from (0..1) to (1..1) (FHIR-30807)
  • Changed cardinality of item.adjudication[allowedunits].value from (0..1) to (1..1) in Inpatient and Outpatient Institutional EOBs
  • Changed Inpatient Institutional EOB adjudication[denialreason].reason cardinality from (0..1) to (1.1.)
  • Changed Outpatient Institutional EOB supportingInfo[pointoforigin].code cardinality from (0..1) to (1..1)
• Added 'Must Support' to Professional and NonClinician EOB item.productOrService and item.modifier (FHIR-30358)
• Fixed Explanations of Benefits Profile Definition diagram and source presentation file (pptx) legend and added DRG owner (FHIR-30360)
• Changed Inpatient EOB insurance cardinality for 1..1 to 1..* by removing constraint in profile (FHIR-31477)
• Removed IG specified requirements of Coverage.Subscriber from the Coverage Profile (FHIR-31535)
• Removed incorrect casting of ExplanationOfBenefit service-date (item.serviced) search parameter (FHIR-30443))
• Added language regarding security and privacy to the Authorization, Authentication, and Registration page with a link to the HL7 FHIR Security and Privacy Module (FHIR-31692)
• Shortened the titles of Inpatient Institutional, Outpatient Institutional, and Professional and NonClinicain EOB Procedure Code and Procedure Code Modifier ValueSets (FHIR-31074)
• Fixed errors in examples
  • Inpatient and Outpatient Institutional EOB examples, removed top-level adjudication because item level adjudication was present (FHIR-29802)
  • Fixed incorrect text in EOB Professional example (FHIR-30372)
• Added missing Diagram in How DaVinci’s PDex IG and the CARIN IG for Blue Button® work together (FHIR-30083)
• Added additional contributors (FHIR-30084)
• Transitioned project structure for Sushi 1.0.0+ (For Implementation Guide generation)