HL7.FHIR.US.CARIN-BB\C4BB ExplanationOfBenefit Outpatient Institutional - Mappings

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 (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.1.0. For a full list of available versions, see the Directory of published versions

Resource Profile: C4BBExplanationOfBenefitOutpatientInstitutional - Mappings

Mappings for the C4BB-ExplanationOfBenefit-Outpatient-Institutional resource profile.

Mappings for Workflow Pattern (http://hl7.org/fhir/workflow)

C4BBExplanationOfBenefitOutpatientInstitutional

ExplanationOfBenefit

Event

identifier

Event.identifier

status

Event.status

type

Event.code

patient

Event.subject

created

Event.occurrence[x]

enterer

Event.performer.agent

insurer

Event.performer.agent

facility

Event.performer.location

Mappings for FiveWs Pattern Mapping (http://hl7.org/fhir/fivews)

C4BBExplanationOfBenefitOutpatientInstitutional

ExplanationOfBenefit

identifier

FiveWs.identifier

status

FiveWs.status

type

FiveWs.class

subType

FiveWs.class

use

FiveWs.class

patient

FiveWs.subject[x], FiveWs.subject

billablePeriod

FiveWs.done[x]

created

FiveWs.recorded

enterer

FiveWs.author

insurer

FiveWs.author

provider

FiveWs.source

referral

FiveWs.cause

facility

FiveWs.where[x]

claim

FiveWs.why[x]

careTeam

provider

FiveWs.actor

item

serviced[x]

FiveWs.done[x]

serviced[x] (servicedDate)

FiveWs.done[x]

location[x]

FiveWs.where[x]

addItem

provider

FiveWs.source

serviced[x]

FiveWs.done[x]

location[x]

FiveWs.where[x]

Mappings for HL7 v2 Mapping (http://hl7.org/v2)

C4BBExplanationOfBenefitOutpatientInstitutional

ExplanationOfBenefit

identifier

use

N/A

type

CX.5

system

CX.4 / EI-2-4

value

CX.1 / EI.1

period

CX.7 + CX.8

assigner

CX.4 / (CX.4,CX.9,CX.10)

billablePeriod

start

DR.1

end

DR.2

priority

Request.priority

insurance

Coverage

Mappings for RIM Mapping (http://hl7.org/v3)

C4BBExplanationOfBenefitOutpatientInstitutional

ExplanationOfBenefit

Entity. Role, or Act

meta

id

n/a

extension

n/a

text

Act.text?

contained

N/A

extension

N/A

modifierExtension

N/A

identifier

id

n/a

extension

n/a

use

Role.code or implied by context

type

Role.code or implied by context

system

II.root or Role.id.root

value

II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)

period

Role.effectiveTime or implied by context

assigner

II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper

billablePeriod

id

n/a

extension

n/a

start

./low

end

./high

n/a

extension

n/a

modifierExtension

N/A

payee

id

n/a

extension

n/a

modifierExtension

N/A

careTeam

id

n/a

extension

n/a

modifierExtension

N/A

supportingInfo

id

n/a

extension

n/a

modifierExtension

N/A

supportingInfo (billingnetworkcontractingstatus)

id

n/a

extension

n/a

modifierExtension

N/A

supportingInfo (clmrecvddate)

id

n/a

extension

n/a

modifierExtension

N/A

supportingInfo (typeofbill)

id

n/a

extension

n/a

modifierExtension

N/A

supportingInfo (pointoforigin)

id

n/a

extension

n/a

modifierExtension

N/A

supportingInfo (admtype)

id

n/a

extension

n/a

modifierExtension

N/A

supportingInfo (discharge-status)

id

n/a

extension

n/a

modifierExtension

N/A

supportingInfo (medicalrecordnumber)

id

n/a

extension

n/a

modifierExtension

N/A

supportingInfo (patientaccountnumber)

id

n/a

extension

n/a

modifierExtension

N/A

diagnosis

id

n/a

extension

n/a

modifierExtension

N/A

procedure

id

n/a

extension

n/a

modifierExtension

N/A

insurance

id

n/a

extension

n/a

modifierExtension

N/A

accident

id

n/a

extension

n/a

modifierExtension

N/A

item

id

n/a

extension

n/a

modifierExtension

N/A

adjudication

id

n/a

extension

n/a

modifierExtension

N/A

adjudication (adjudicationamounttype)

id

n/a

extension

n/a

modifierExtension

N/A

adjudication (denialreason)

id

n/a

extension

n/a

modifierExtension

N/A

adjudication (allowedunits)

id

n/a

extension

n/a

modifierExtension

N/A

detail

id

n/a

extension

n/a

modifierExtension

N/A

subDetail

id

n/a

extension

n/a

modifierExtension

N/A

addItem

id

n/a

extension

n/a

modifierExtension

N/A

detail

id

n/a

extension

n/a

modifierExtension

N/A

subDetail

id

n/a

extension

n/a

modifierExtension

N/A

adjudication

id

n/a

extension

n/a

modifierExtension

N/A

adjudication (adjudicationamounttype)

id

n/a

extension

n/a

modifierExtension

N/A

adjudication (denialreason)

id

n/a

extension

n/a

modifierExtension

N/A

total

id

n/a

extension

n/a

modifierExtension

N/A

total (adjudicationamounttype)

id

n/a

extension

n/a

modifierExtension

N/A

total (benefitpaymentstatus)

id

n/a

extension

n/a

modifierExtension

N/A

payment

id

n/a

extension

n/a

modifierExtension

N/A

processNote

id

n/a

extension

n/a

modifierExtension

N/A

benefitBalance

id

n/a

extension

n/a

modifierExtension

N/A

financial

id

n/a

extension

n/a

modifierExtension

N/A