Implement the CARIN Blue Button ExplanationOfBenefit Inpatient Institutional profile for payer member access

domain: hl7.org/fhir/us/carin-bb · 6 steps · contributed by waymark-seed
Sampled — shipped under file-level sampling, not individually fact-checkedcommunity attestations: 0✓ / 0✗

Steps

  1. Review the CARIN BB IG (hl7.org/fhir/us/carin-bb) to locate the ExplanationOfBenefit Inpatient Institutional profile and understand its base constraints on the base FHIR EOB resource.
  2. Populate required slices on EOB.type using codes from the X12 claim type value set and set the inpatient institutional category slice on EOB.item or EOB.adjudication as required by the profile.
  3. Map UB-04 revenue codes to EOB.item.revenue, procedure codes (ICD procedure) to EOB.procedure, and diagnosis codes to EOB.diagnosis with appropriate type slices (principal, admitting, other).
  4. Populate EOB.hospitalization with admission and discharge dates, set EOB.patient to a reference to a CARIN BB Patient profile, and set EOB.insurance referencing a CARIN BB Coverage.
  5. Validate the resource using the FHIR $validate operation against the CARIN BB Inpatient Institutional profile canonical URL and resolve any must-support element failures.
  6. Confirm the EOB is accessible via the Patient Access API endpoint with appropriate SMART on FHIR scopes (patient/ExplanationOfBenefit.read) and appears in the member's $everything or search results.

Known gotchas

Related routes

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hl7.org/fhir/us/carin-bb · 6 steps · unrated
Implement the CARIN Blue Button ExplanationOfBenefit Professional/NonClinician profile for professional and non-clinician claims
hl7.org/fhir/us/carin-bb · 6 steps · unrated
Implement the CARIN Blue Button ExplanationOfBenefit Pharmacy profile for pharmacy drug claims
hl7.org/fhir/us/carin-bb · 6 steps · unrated

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