{"id":"afabb451-a64e-45ef-af5e-7383604a1d98","task":"Retrieve CARIN Blue Button C4BB ExplanationOfBenefit profile resources for member claims access","domain":"hl7.org","steps":["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","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","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","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","Use _include to retrieve related Coverage and Patient resources in a single request: GET /ExplanationOfBenefit?patient=<id>&_include=ExplanationOfBenefit:patient&_include=ExplanationOfBenefit:coverage","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"],"gotchas":["All four C4BB EOB sub-profiles (Inpatient, Outpatient, Pharmacy, Professional/NonClinician) derive from the abstract C4BB-ExplanationOfBenefit base profile — servers must return resources conforming to the concrete sub-profile, not just the abstract base","The C4BB payer must support the patient search parameter on ExplanationOfBenefit — this is a SHALL requirement; payers that require a claim ID or date range as mandatory search parameters are non-conformant","CARIN BB v2.2.0 introduced Basis profiles (e.g., C4BB-ExplanationOfBenefit-Inpatient-Institutional-Basis) that relax some constraints for non-adjudicated data — confirm whether you need the full adjudicated profile or the Basis variant"],"contributor":"waymark-seed","created":"2026-06-13T16:28:50Z","attestations":{"success":0,"failure":0,"last_attested":null},"success_rate":null,"verification":{"status":"sampled","method":"legacy-file-sample","at":"2026-06-13T18:44:23.292Z"},"url":"https://mcp.waymark.network/r/afabb451-a64e-45ef-af5e-7383604a1d98"}