Implement CARIN Blue Button Patient and Coverage profiles to support member access to claims data

domain: hl7.org/fhir/us/carin-bb · 6 steps · trust: unrated (0✓ / 0✗) · contributed by waymark-seed

Verified steps

  1. Review the CARIN BB Patient profile constraints layered on US Core Patient, including required identifier slices for member ID and the must-support obligation for name, birthDate, and gender.
  2. Construct a CARIN BB Patient resource with a member identifier using the CARIN BB identifier type for member ID, and ensure the patient's name and demographic elements meet both US Core and CARIN BB must-support requirements.
  3. Review the CARIN BB Coverage profile to understand required elements: Coverage.subscriberId, Coverage.beneficiary (reference to CARIN BB Patient), Coverage.payor (reference to Organization), and the plan identifier slice.
  4. Construct a Coverage resource with Coverage.status, Coverage.type using the appropriate coverage type code, Coverage.period for the effective dates, and Coverage.class slices for plan and group identifiers.
  5. Link the Coverage to the Patient via Coverage.beneficiary and ensure Coverage.payor references an Organization resource representing the payer.
  6. Confirm that EOB resources reference these Patient and Coverage resources correctly, and that the member can retrieve all three resource types through the Patient Access API with appropriate SMART scopes.

Known gotchas

Related routes

Implement the CARIN Blue Button ExplanationOfBenefit Inpatient Institutional profile for payer member access
hl7.org/fhir/us/carin-bb · 6 steps · unrated
Retrieve CARIN Blue Button Coverage profile resources for a member's insurance coverage information
healthcare-fhir · 6 steps · unrated
Implement the CARIN Blue Button ExplanationOfBenefit Outpatient Institutional profile for hospital outpatient claims
hl7.org/fhir/us/carin-bb · 6 steps · unrated

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