CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
1.1.0 - STU1 Update
CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
1.1.0 - STU1 Update
This page is part of the CARIN Blue Button Implementation Guide (v1.1.0: 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 
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:ExplanationOfBenefit;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "EOBOutpatientInstitutional1"];
fhir:Resource.meta [
fhir:Meta.lastUpdated [ fhir:value "2019-12-12T09:14:11+00:00"^^xsd:dateTime ];
fhir:Meta.profile [
fhir:value "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional";
fhir:index 0;
fhir:link <http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional> ], [
fhir:value "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional|1.1.0";
fhir:index 1;
fhir:link <http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional|1.1.0> ]
];
fhir:Resource.language [ fhir:value "en-US"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en-US\" lang=\"en-US\"><p><b>Generated Narrative</b></p><p><b>identifier</b>: Unique Claim ID: AW123412341234123412341234123412</p><p><b>status</b>: active</p><p><b>type</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>subType</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType outpatient}\">Outpatient</span></p><p><b>use</b>: claim</p><p><b>patient</b>: <a href=\"Patient-Patient1.html\">Generated Summary: language: en-US; Member Number: 1234-234-1243-12345678901, Unique Member ID: 1234-234-1243-12345678901u; active; Johnny Example1 ; Phone: (301)666-1212; gender: male; birthDate: 1986-01-01; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-NullFlavor UNK}\">unknown</span></a></p><p><b>billablePeriod</b>: 2019-01-01 --> 2019-10-31</p><p><b>created</b>: Nov 2, 2019 12:00:00 AM</p><p><b>insurer</b>: <a href=\"Organization-Payer1.html\">XXX Health Plan. Generated Summary: language: en-US; National Provider Identifier: 345678, Payer ID: 901234; active; name: Payer 1</a></p><p><b>provider</b>: <a href=\"Organization-OrganizationProvider1.html\">XXX Health Plan. Generated Summary: language: en-US; National Provider Identifier: 345678, Tax ID number: 123-45-6789; active; name: Provider 1</a></p><p><b>outcome</b>: partial</p><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 1</p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType billingnetworkcontractingstatus}\">Billing Network Contracting Status</span></p><p><b>code</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus contracted}\">Contracted</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 2</p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType clmrecvddate}\">Claim Received Date</span></p><p><b>timing</b>: 2019-11-30</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 3</p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType typeofbill}\">Type of Bill</span></p><p><b>code</b>: <span title=\"Codes: {https://www.nubc.org/CodeSystem/TypeOfBill Dummy}\">Dummy</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 4</p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType pointoforigin}\">Point Of Origin</span></p><p><b>code</b>: <span title=\"Codes: {https://www.nubc.org/CodeSystem/PointOfOrigin Dummy}\">Dummy</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 5</p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType admtype}\">Admission Type</span></p><p><b>code</b>: <span title=\"Codes: {https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit Dummy}\">Dummy</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 6</p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType discharge-status}\">Discharge Status</span></p><p><b>code</b>: <span title=\"Codes: {https://www.nubc.org/CodeSystem/PatDischargeStatus Dummy}\">Dummy</span></p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 7</p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType medicalrecordnumber}\">Medical Record Number</span></p><p><b>value</b>: 1234-234-1243-12345678901m</p></blockquote><blockquote><p><b>supportingInfo</b></p><p><b>sequence</b>: 8</p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType patientaccountnumber}\">Patient Account Number</span></p><p><b>value</b>: 1234-234-1243-12345678901a</p></blockquote><h3>Diagnoses</h3><table class=\"grid\"><tr><td>-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td>*</td><td>1</td><td><span title=\"Codes: {http://hl7.org/fhir/sid/icd-10-cm S06.0X1A}\">Concussion w LOC of 30 minutes or less, init</span></td><td><span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType patientreasonforvisit}\">Patient Reason for Visit</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td>-</td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td>*</td><td>true</td><td><a href=\"Coverage-Coverage1.html\">Generated Summary: language: en-US; Member Number: 1234-234-1243-12345678901; status: active; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/v3-ActCode HIP}\">health insurance plan policy</span>; subscriberId: 12345678901; dependent: 01; <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span>; period: 2019-01-01 --> 2019-10-31; network: XYZ123-UPMC CONSUMER ADVA</a></td></tr></table><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication paidtoprovider}\">Payment Amount</span></p></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication paidbypatient}\">Patient Pay Amount</span></p></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication paidtoprovider}\">Payment Amount</span></p></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes: {http://terminology.hl7.org/CodeSystem/adjudication submitted}\">Submitted Amount</span></p></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication paidbypatient}\">Patient Pay Amount</span></p></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes: {http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus innetwork}\">In Network</span></p></blockquote></div>"
];
fhir:ExplanationOfBenefit.identifier [
fhir:index 0;
fhir:Identifier.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType" ];
fhir:Coding.code [ fhir:value "uc" ] ] ];
fhir:Identifier.system [ fhir:value "https://www.xxxplan.com/fhir/EOBIdentifier" ];
fhir:Identifier.value [ fhir:value "AW123412341234123412341234123412" ]
];
fhir:ExplanationOfBenefit.status [ fhir:value "active"];
fhir:ExplanationOfBenefit.type [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ];
fhir:Coding.code [ fhir:value "institutional" ] ];
fhir:CodeableConcept.text [ fhir:value "Institutional" ]
];
fhir:ExplanationOfBenefit.subType [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBInstitutionalClaimSubType" ];
fhir:Coding.code [ fhir:value "outpatient" ] ];
fhir:CodeableConcept.text [ fhir:value "Outpatient" ]
];
fhir:ExplanationOfBenefit.use [ fhir:value "claim"];
fhir:ExplanationOfBenefit.patient [
fhir:Reference.reference [ fhir:value "Patient/Patient1" ]
];
fhir:ExplanationOfBenefit.billablePeriod [
fhir:Period.start [ fhir:value "2019-01-01"^^xsd:date ];
fhir:Period.end [ fhir:value "2019-10-31"^^xsd:date ]
];
fhir:ExplanationOfBenefit.created [ fhir:value "2019-11-02T00:00:00+00:00"^^xsd:dateTime];
fhir:ExplanationOfBenefit.insurer [
fhir:Reference.reference [ fhir:value "Organization/Payer1" ];
fhir:Reference.display [ fhir:value "XXX Health Plan" ]
];
fhir:ExplanationOfBenefit.provider [
fhir:Reference.reference [ fhir:value "Organization/OrganizationProvider1" ];
fhir:Reference.display [ fhir:value "XXX Health Plan" ]
];
fhir:ExplanationOfBenefit.outcome [ fhir:value "partial"];
fhir:ExplanationOfBenefit.supportingInfo [
fhir:index 0;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType" ];
fhir:Coding.code [ fhir:value "billingnetworkcontractingstatus" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus" ];
fhir:Coding.code [ fhir:value "contracted" ] ] ]
], [
fhir:index 1;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "2"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType" ];
fhir:Coding.code [ fhir:value "clmrecvddate" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.timingDate [ fhir:value "2019-11-30"^^xsd:date ]
], [
fhir:index 2;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "3"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType" ];
fhir:Coding.code [ fhir:value "typeofbill" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.nubc.org/CodeSystem/TypeOfBill" ];
fhir:Coding.code [ fhir:value "Dummy" ] ] ]
], [
fhir:index 3;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "4"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType" ];
fhir:Coding.code [ fhir:value "pointoforigin" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.nubc.org/CodeSystem/PointOfOrigin" ];
fhir:Coding.code [ fhir:value "Dummy" ] ] ]
], [
fhir:index 4;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "5"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType" ];
fhir:Coding.code [ fhir:value "admtype" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.nubc.org/CodeSystem/PriorityTypeOfAdmitOrVisit" ];
fhir:Coding.code [ fhir:value "Dummy" ] ] ]
], [
fhir:index 5;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "6"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType" ];
fhir:Coding.code [ fhir:value "discharge-status" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.code [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "https://www.nubc.org/CodeSystem/PatDischargeStatus" ];
fhir:Coding.code [ fhir:value "Dummy" ] ] ]
], [
fhir:index 6;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "7"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType" ];
fhir:Coding.code [ fhir:value "medicalrecordnumber" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.valueString [ fhir:value "1234-234-1243-12345678901m" ]
], [
fhir:index 7;
fhir:ExplanationOfBenefit.supportingInfo.sequence [ fhir:value "8"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.supportingInfo.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType" ];
fhir:Coding.code [ fhir:value "patientaccountnumber" ] ] ];
fhir:ExplanationOfBenefit.supportingInfo.valueString [ fhir:value "1234-234-1243-12345678901a" ]
];
fhir:ExplanationOfBenefit.diagnosis [
fhir:index 0;
fhir:ExplanationOfBenefit.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ];
fhir:ExplanationOfBenefit.diagnosis.diagnosisCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/sid/icd-10-cm" ];
fhir:Coding.code [ fhir:value "S06.0X1A" ] ] ];
fhir:ExplanationOfBenefit.diagnosis.type [
fhir:index 0;
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType" ];
fhir:Coding.code [ fhir:value "patientreasonforvisit" ] ] ]
];
fhir:ExplanationOfBenefit.insurance [
fhir:index 0;
fhir:ExplanationOfBenefit.insurance.focal [ fhir:value "true"^^xsd:boolean ];
fhir:ExplanationOfBenefit.insurance.coverage [
fhir:Reference.reference [ fhir:value "Coverage/Coverage1" ] ]
];
fhir:ExplanationOfBenefit.adjudication [
fhir:index 0;
fhir:ExplanationOfBenefit.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication" ];
fhir:Coding.code [ fhir:value "paidtoprovider" ] ];
fhir:CodeableConcept.text [ fhir:value "Payment Amount" ] ];
fhir:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "620"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 1;
fhir:ExplanationOfBenefit.item.adjudication.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication" ];
fhir:Coding.code [ fhir:value "paidbypatient" ] ];
fhir:CodeableConcept.text [ fhir:value "Patient Pay Amount" ] ];
fhir:ExplanationOfBenefit.item.adjudication.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ] ]
];
fhir:ExplanationOfBenefit.total [
fhir:index 0;
fhir:ExplanationOfBenefit.total.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication" ];
fhir:Coding.code [ fhir:value "paidtoprovider" ] ];
fhir:CodeableConcept.text [ fhir:value "Payment Amount" ] ];
fhir:ExplanationOfBenefit.total.amount [
fhir:Money.value [ fhir:value "620"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 1;
fhir:ExplanationOfBenefit.total.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ];
fhir:Coding.code [ fhir:value "submitted" ] ];
fhir:CodeableConcept.text [ fhir:value "Submitted Amount" ] ];
fhir:ExplanationOfBenefit.total.amount [
fhir:Money.value [ fhir:value "2650"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 2;
fhir:ExplanationOfBenefit.total.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication" ];
fhir:Coding.code [ fhir:value "paidbypatient" ] ];
fhir:CodeableConcept.text [ fhir:value "Patient Pay Amount" ] ];
fhir:ExplanationOfBenefit.total.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
], [
fhir:index 3;
fhir:ExplanationOfBenefit.total.category [
fhir:CodeableConcept.coding [
fhir:index 0;
fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus" ];
fhir:Coding.code [ fhir:value "innetwork" ] ] ];
fhir:ExplanationOfBenefit.total.amount [
fhir:Money.value [ fhir:value "0"^^xsd:decimal ];
fhir:Money.currency [ fhir:value "USD" ] ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2020+ HL7 Financial Management Working Group. Package hl7.fhir.us.carin-bb#1.1.0 based on FHIR 4.0.1. Generated 2021-07-02
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