Review the CARIN BB IG adjudication section to understand the defined adjudication category slices: submitted amount, eligible amount, benefit amount, and (for pharmacy) additional slices such as discount and member liability.
On EOB.item.adjudication, implement each required slice using the CARIN BB adjudication category code system and populate the amount element with the corresponding monetary value from the payer's adjudication data.
On EOB.total, implement aggregate total slices for the entire claim, mirroring the item-level adjudication categories at the claim level (e.g., total submitted, total eligible, total benefit).
Ensure the adjudication category codes reference the CARIN BB-defined value set for adjudication categories, not the base FHIR adjudication code system.
Handle cases where a specific adjudication amount is zero — populate the slice with a zero amount rather than omitting the slice, as omission may be interpreted as the payer not having adjudicated that component.
Validate that all required slices are present using the FHIR $validate operation and confirm that slice discriminators resolve correctly per the profile's slicing rules on adjudication.category.
Known gotchas
CARIN BB uses a slicing discriminator on EOB.item.adjudication.category.coding.code — each required category code must appear exactly once per item; duplicate slices or missing required categories cause validation errors.
The 'benefit' slice represents what the plan paid (plan paid amount), not the beneficiary's benefit in the broader sense — ETL processes that conflate benefit with eligible or submitted amounts will produce incorrect data.
EOB.total slices must use the same category code system as item-level adjudication; using a different system or code URI at the claim level vs. the item level is a common inconsistency that breaks validation.
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