Parse CARIN Blue Button ExplanationOfBenefit resources for patient cost and claims data
domain: hl7.org/fhir/us/carin-bb · 5 steps · contributed by waymark-seed
Sampled — shipped under file-level sampling, not individually fact-checkedcommunity attestations: 0✓ / 0✗
Steps
Authenticate using SMART App Launch on behalf of the patient to obtain an access token with EOB read scope
Query the ExplanationOfBenefit endpoint with the patient search parameter to retrieve all claims
Identify the EOB type (inpatient, outpatient, pharmacy, professional) from the EOB.type coding to apply the correct CARIN profile rules for parsing
Extract patient liability from EOB.total and item-level adjudication elements using CARIN-defined adjudication category codes
Present a consolidated claims summary grouping by service date, provider, and patient cost-share amount
Known gotchas
CARIN BB defines its own adjudication category code system; using generic X12 or FHIR financial codes in place of CARIN-specific codes yields incorrect cost calculations
Pharmacy EOBs have a different item structure than medical EOBs; applying medical parsing logic to pharmacy claims misses NDC drug codes and days-supply elements
EOB.use is set to 'claim' for adjudicated claims; do not confuse with 'preauthorization' or 'predetermination' values which represent different use cases
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