Retrieve CARIN Blue Button C4BB ExplanationOfBenefit profile resources for member claims access

In-depth guide

Steps

1. Authenticate the member-facing application via SMART on FHIR standalone launch, obtaining patient/*.read or patient/ExplanationOfBenefit.read scope from the payer's authorization server
2. Retrieve the member's ExplanationOfBenefit resources: GET /ExplanationOfBenefit?patient=<patient-id>&_sort=-created to get the most recent claims; the payer server must support this mandatory search parameter combination per the CARIN BB CapabilityStatement
3. Identify the EOB profile type from ExplanationOfBenefit.type.coding using the C4BB claim type value set: Professional/NonClinician, Inpatient Institutional, Outpatient Institutional, or Pharmacy — each has a distinct C4BB sub-profile
4. Parse profile-specific fields: for Inpatient Institutional EOBs, check the admission/discharge dates in item.servicedPeriod and DRG in diagnosisRelatedGroup; for Pharmacy EOBs, check the NCPDP claim number and compound drug indicators
5. Use _include to retrieve related Coverage and Patient resources in a single request: GET /ExplanationOfBenefit?patient=<id>&_include=ExplanationOfBenefit:patient&_include=ExplanationOfBenefit:coverage
6. Validate the received EOB resources against the CARIN BB v2.1.0 package (hl7.fhir.us.carin-bb#2.1.0) to confirm adjudication slices (submitted, eligible, benefit, member-paid) are present as required