| Package | hl7.fhir.us.carin-bb |
| Type | ImplementationGuide |
| Id | Id |
| FHIR Version | R4 |
| Source | http://hl7.org/fhir/us/carin-bb/https://build.fhir.org/ig/HL7/carin-bb/index.html |
| Url | http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb |
| Version | 2.1.0 |
| Status | active |
| Date | 2024-12-12T20:01:15+00:00 |
| Name | CARINConsumerDirectedPayerDataExchange |
| Title | CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) |
| Experimental | False |
| Realm | us |
| Authority | hl7 |
| Description | CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) |
| CapabilityStatement | |
c4bb  | C4BB CapabilityStatement |
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: ImplementationGuide hl7.fhir.us.carin-bb
The official URL for this implementation guide is:
http://hl7.org/fhir/us/carin-bb/ImplementationGuide/hl7.fhir.us.carin-bb
CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
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{
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"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "fmm-definition"
},
{
"url" : "value",
"valueString" : "http://hl7.org/fhir/versions.html#maturity"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "propagate-status"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "excludelogbinaryformat"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
},
{
"extension" : [
{
"url" : "code",
"valueCode" : "tabbed-snapshots"
},
{
"url" : "value",
"valueString" : "true"
}
],
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter"
}
],
"grouping" : [
{
"id" : "capability",
"name" : "Behavior: Capability Statements",
"description" : "The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements."
},
{
"id" : "search",
"name" : "Behavior: Search Parameters",
"description" : "These define the properties by which a RESTful server can be searched. They can also be used for sorting and including related resources."
},
{
"id" : "abstract",
"name" : "Structures: Abstract Profiles",
"description" : "These are profiles on resources or data types that describe patterns used by other profiles, but cannot be instantiated directly. I.e. instances can conform to profiles based on these abstract profiles, but do not declare conformance to the abstract profiles themselves."
},
{
"id" : "basis",
"name" : "Structures: Explanation of Benefits Basis Profiles",
"description" : "Basis profiles that define all non-financial element requirements for ExplanationOfBenefit types. These profiles are not expected to be implemented directly within the context of the consumer directed data exchange use case defined by this guide, but rather from within the context in which external guides may define (e.g. Provider Access API of PDEX)."
},
{
"id" : "profiles",
"name" : "Structures: Resource Profiles",
"description" : "These define constraints on FHIR resources for systems conforming to this implementation guide."
}
],
"resource" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/ADADentalProcedureCode"
},
"name" : "ADA Code on Dental Procedures and Nomenclature Value Set",
"description" : "The purpose of the CDT Code is to achieve uniformity, consistency and specificity in accurately documenting dental treatment. One use of the CDT Code is to provide for the efficient processing of dental claims, and another is to populate an Electronic Health Record.\n\nOn August 17, 2000 the CDT Code was named as a HIPAA standard code set. Any claim submitted on a HIPAA standard electronic dental claim must use dental procedure codes from the version of the CDT Code in effect on the date of service. The CDT Code is also used on paper dental claims, and the ADA's paper claim form data content reflects the HIPAA electronic standard.\n\nCDT is published Annually. Versions should refect the YYYY of the release.\n\nThe Council on Dental Benefit Programs (CDBP) has ADA Bylaws responsibility for CDT Code maintenance. To fulfill this obligation CDBP established its Code Maintenance Committee (CMC), a body that includes representatives from various sectors of the dental community (e.g., ADA; dental specialty organizations; third-party payers). CMC members, by their votes, determine which of the requested actions are incorporated into the CDT Code.\n\nPlease see Code Maintenance Committee (CMC) page for information about the CMC's members and activities.\n\nTo obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/ADAUniversalNumberingSystem"
},
"name" : "American Dental Association Universal Numbering Value Set",
"description" : "The American Dental Association Universal Numbering System is a tooth notation system primarily used in the United States.\n\nTeeth are numbered from the viewpoint of the dental practitioner looking into the open mouth, clockwise starting from the distalmost right maxillary teeth.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/BB-EOBOral1-nonfinancial"
},
"name" : "BB-EOBOral1-nonfinancial",
"description" : "EOB Oral Example 1 - Nonfinancial",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/BB-EOBOral2-nonfinancial"
},
"name" : "BB-EOBOral2-nonfinancial",
"description" : "EOB Oral Example 2 - Nonfinancial",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/BB-EOBPharmacy1-nonfinancial"
},
"name" : "BB-EOBPharmacy1-nonfinancial",
"description" : "EOB Pharmacy Example 1 - Nonfinancial",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBAdjudicationCategoryDiscriminator"
},
"name" : "C4BB Adjudication Category Discriminator Value Set",
"description" : "Used as the discriminator for adjudication.category and item.adjudication.category for the CARIN IG for Blue Button®",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBAdjudication"
},
"name" : "C4BB Adjudication Code System",
"description" : "Describes the various amount fields used when payers receive and adjudicate a claim. It complements the values defined in http://terminology.hl7.org/CodeSystem/adjudication.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBAdjudicationDiscriminator"
},
"name" : "C4BB Adjudication Discriminator Code System",
"description" : "Used as the discriminator for the data elements in adjudication and item.adjudication.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBAdjudication"
},
"name" : "C4BB Adjudication Value Set",
"description" : "Describes the various amount fields used when payers receive and adjudicate a claim. It includes the values \ndefined in http://terminology.hl7.org/CodeSystem/adjudication, as well as those defined in the C4BB Adjudication CodeSystem.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBAmbulanceTransportReasonCodes"
},
"name" : "C4BB Ambulance Transport Reasons Value Set",
"description" : "Transportation Services Ambulatory Transport Reason Codes",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CapabilityStatement"
}
],
"reference" : {
"reference" : "CapabilityStatement/c4bb"
},
"name" : "C4BB CapabilityStatement",
"description" : "This Section describes the expected capabilities of the C4BB Server actor which is responsible for providing responses to the queries submitted by the C4BB Requestors. \n\nThe EOB Resource is the focal Consumer-Directed Payer Data Exchange (CDPDE) Resource. Several Reference Resources are defined directly/indirectly from the EOB: Coverage, Patient, Organization (Payer ID), Practioner, and Organization (Facility).\n\nThe Coverage Reference Resource SHALL be returned with data that was effective as of the date of service of the claim; for example, the data will reflect the employer name in effect at that time. However, for other reference resources, payers MAY decide to provide either the data that was in effect as of the date of service or the current data. All reference resources within the EOB will have meta.lastUpdated flagged as must support. Payers SHALL provide the last time the data was updated or the date of creation in the payers system of record, whichever comes last. Apps will use the meta.lastUpdated values to determine if the reference resources are as of the current date or date of service.",
"exampleBoolean" : false,
"groupingId" : "capability"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBClaimCareTeamRole"
},
"name" : "C4BB Claim Care Team Role Code System",
"description" : "Describes functional roles of the care team members. Complements http://terminology.hl7.org/CodeSystem/claimcareteamrole.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBClaimDiagnosisType"
},
"name" : "C4BB Claim Diagnosis Type Code System",
"description" : "Indicates if the institutional diagnosis is admitting, principal, secondary, other, an external cause of injury or a patient reason for visit. Complements http://terminology.hl7.org/CodeSystem/ex-diagnosistype.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBClaimIdentifierType"
},
"name" : "C4BB Claim Identifier Type Value Set",
"description" : "Indicates that the claim identifier is that assigned by a payer for a claim received from a provider or subscriber",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBClaimInpatientInstitutionalDiagnosisType"
},
"name" : "C4BB Claim Inpatient Institutional Diagnosis Type Value Set",
"description" : "Indicates if the inpatient institutional diagnosis is admitting, principal, other or an external cause of injury.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBClaimInstitutionalCareTeamRole"
},
"name" : "C4BB Claim Institutional Care Team Role Value Set",
"description" : "Describes functional roles of the care team members.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBClaimOutpatientInstitutionalDiagnosisType"
},
"name" : "C4BB Claim Outpatient Institutional Diagnosis Type Value Set",
"description" : "Indicates if the outpatient institutional diagnosis is principal, other, an external cause of injury or a patient reason for visit.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBClaimPharmacyTeamRole"
},
"name" : "C4BB Claim Pharmacy CareTeam Role Value Set",
"description" : "Describes functional roles of the care team members",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBClaimProcedureType"
},
"name" : "C4BB Claim Procedure Type Code System",
"description" : "Indicates if the inpatient institutional procedure (ICD-PCS) is the principal procedure or another procedure.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBClaimProcedureType"
},
"name" : "C4BB Claim Procedure Type Value Set",
"description" : "Indicates if the inpatient institutional procedure (ICD-PCS) is the principal procedure or another procedure",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBClaimProfessionalAndNonClinicianCareTeamRole"
},
"name" : "C4BB Claim Professional And Non Clinician Care Team Role Value Set",
"description" : "Describes functional roles of the care team members",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBClaimProfessionalAndNonClinicianDiagnosisType"
},
"name" : "C4BB Claim Professional And Non Clinician Diagnosis Type Value Set",
"description" : "Indicates if the professional and non-clinician diagnosis is principal or secondary",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBCompoundLiteral"
},
"name" : "C4BB Compound Literal Code System",
"description" : "CodeSystem for a Literal 'compound' value.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-Coverage"
},
"name" : "C4BB Coverage",
"description" : "Data that reflect a payer’s coverage that was effective as of the date of service or the date of admission of the claim.",
"exampleBoolean" : false,
"groupingId" : "profiles"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource:abstract"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-ExplanationOfBenefit"
},
"name" : "C4BB Explanation Of Benefit",
"description" : "Abstract parent profile that includes constraints that are common to the four specific ExplanationOfBenefit (EOB) profiles defined in this Implementation Guide.\nAll EOB instances should be from one of the four concrete EOB profiles defined in this Implementation Guide: Inpatient, Outpatient, Pharmacy, and Professional/NonClinician",
"exampleBoolean" : false,
"groupingId" : "abstract"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional"
},
"name" : "C4BB ExplanationOfBenefit Inpatient Institutional",
"description" : "The profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for inpatient services, which may include the use of equipment and supplies, laboratory services, radiology services and other charges. Inpatient claims are submitted for services rendered at an institution as part of an overnight stay.\nThe claims data is based on the institutional claim format UB-04, submission standards adopted by the Department of Health and Human\nServices.\nThe profile has requirements for financial data.",
"exampleBoolean" : false,
"groupingId" : "profiles"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional-Basis"
},
"name" : "C4BB ExplanationOfBenefit Inpatient Institutional Basis",
"description" : "The basis profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for inpatient services, which may include the use of equipment and supplies, laboratory services, radiology services and other charges. Inpatient claims are submitted for services rendered at an institution as part of an overnight stay.\nThe claims data is based on the institutional claim format UB-04, submission standards adopted by the Department of Health and Human\nServices.\nThe basis profile does not have requirements for financial data.",
"exampleBoolean" : false,
"groupingId" : "basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-ExplanationOfBenefit-Oral"
},
"name" : "C4BB ExplanationOfBenefit Oral",
"description" : "This profile is used for Explanation of Benefits (EOBs) based on claims submitted by providers of oral services including Dental, Denture and Hygiene. The ADA Dental Claim Form provides a common format for reporting dental services to a patient's dental benefit plan.\nThe profile has requirements for financial data.",
"exampleBoolean" : false,
"groupingId" : "profiles"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis"
},
"name" : "C4BB ExplanationOfBenefit Oral Basis",
"description" : "This profile is used for Explanation of Benefits (EOBs) based on claims submitted by providers of oral services including Dental, Denture and Hygiene. The ADA Dental Claim Form provides a common format for reporting dental services to a patient's dental benefit plan.\nThe basis profile does not have requirements for financial data.",
"exampleBoolean" : false,
"groupingId" : "basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"
},
"name" : "C4BB ExplanationOfBenefit Outpatient Institutional",
"description" : "This profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for outpatient services, which may include including the use of equipment and supplies, laboratory services, radiology services and other charges. Outpatient claims are submitted for services rendered at an institution that are not part of an overnight stay.\nThe claims data is based on the institutional claim form UB-04, submission standards adopted by the Department of Health and Human Services.\nThe profile has requirements for financial data.",
"exampleBoolean" : false,
"groupingId" : "profiles"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis"
},
"name" : "C4BB ExplanationOfBenefit Outpatient Institutional Basis",
"description" : "This profile is used for Explanation of Benefits (EOBs) based on claims submitted by clinics, hospitals, skilled nursing facilities and other institutions for outpatient services, which may include including the use of equipment and supplies, laboratory services, radiology services and other charges. Outpatient claims are submitted for services rendered at an institution that are not part of an overnight stay.\nThe claims data is based on the institutional claim form UB-04, submission standards adopted by the Department of Health and Human Services.\nThe basis profile does not have requirements for financial data.",
"exampleBoolean" : false,
"groupingId" : "basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy"
},
"name" : "C4BB ExplanationOfBenefit Pharmacy",
"description" : "This profile is used for Explanation of Benefits (EOBs) based on claims submitted by retail pharmacies.\nThe claims data is based on submission standards adopted by the Department of Health and Human Services defined by NCPDP (National Council for Prescription Drug Program)\nThe profile has requirements for financial data.",
"exampleBoolean" : false,
"groupingId" : "profiles"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis"
},
"name" : "C4BB ExplanationOfBenefit Pharmacy Basis",
"description" : "This profile is used for Explanation of Benefits (EOBs) based on claims submitted by retail pharmacies.\nThe claims data is based on submission standards adopted by the Department of Health and Human Services defined by NCPDP (National Council for Prescription Drug Program)\nThe basis profile does not have requirements for financial data.",
"exampleBoolean" : false,
"groupingId" : "basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"
},
"name" : "C4BB ExplanationOfBenefit Professional NonClinician",
"description" : "This profile is used for Explanation of Benefits (EOBs) based on claims submitted by physicians, suppliers and other non-institutional providers for professional and vision services. These services may be rendered in inpatient or outpatient, including office locations. The claims data is based on the professional claim form 1500, submission standards adopted by the Department of Health and Human Services as form CMS-1500.\nThe profile has requirements for financial data.",
"exampleBoolean" : false,
"groupingId" : "profiles"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician-Basis"
},
"name" : "C4BB ExplanationOfBenefit Professional NonClinician Basis",
"description" : "This profile is used for Explanation of Benefits (EOBs) based on claims submitted by physicians, suppliers and other non-institutional providers for professional and vision services. These services may be rendered in inpatient or outpatient, including office locations. The claims data is based on the professional claim form 1500, submission standards adopted by the Department of Health and Human Services as form CMS-1500.\nThe basis profile does not have requirements for financial data.",
"exampleBoolean" : false,
"groupingId" : "basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBIdentifierType"
},
"name" : "C4BB Identifier Type Code System",
"description" : "Identifier Type codes that extend those defined in http://terminology.hl7.org/CodeSystem/v2-0203 to define the type of identifier payers and providers assign to claims and patients.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBInstitutionalClaimSubType"
},
"name" : "C4BB Institutional Claim SubType Code System",
"description" : "Indicates if institutional ExplanationOfBenefit is inpatient or outpatient.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBInstitutionalClaimSubType"
},
"name" : "C4BB Institutional Claim SubType Value Set",
"description" : "Indicates if institutional ExplanationOfBenefit is inpatient or outpatient.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-Organization"
},
"name" : "C4BB Organization",
"description" : "This profile builds upon the US Core Organization profile. It is used to convey a payer, provider, payee or service facility organization.",
"exampleBoolean" : false,
"groupingId" : "profiles"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBOrganizationIdentifierType"
},
"name" : "C4BB Organization Identifier Type Value Set",
"description" : "Identifies the type of identifiers for organizations",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-Patient"
},
"name" : "C4BB Patient",
"description" : "This profile builds upon the US Core Patient profile. It is used to convey information about the patient who received the services described on the claim.",
"exampleBoolean" : false,
"groupingId" : "profiles"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBPatientIdentifierType"
},
"name" : "C4BB Patient Identifier Type Value Set",
"description" : "Identifies the type of identifier payers and providers assign to patients",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBPayeeType"
},
"name" : "C4BB Payee Type Code System",
"description" : "Indicates that a payee type may be a beneficiary.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBPayeeType"
},
"name" : "C4BB Payee Type Value Set",
"description" : "Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBPayerAdjudicationStatus"
},
"name" : "C4BB Payer Adjudication Status Code System",
"description" : "Describes the various status fields used when payers adjudicate a claim, such as whether the claim was adjudicated in or out of network, if the provider was in or not in network for the service.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBPayerBenefitPaymentStatus"
},
"name" : "C4BB Payer Benefit Payment Status Value Set",
"description" : "Indicates the in network or out of network payment status of the claim.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBPayerClaimPaymentStatusCode"
},
"name" : "C4BB Payer Claim Payment Status Code Value Set",
"description" : "Indicates whether the claim / item was paid or denied.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBPayerProviderNetworkStatus"
},
"name" : "C4BB Payer Provider Network Status Value Set",
"description" : "Indicates the provider network status in relation to a patient's coverage as of the effective date of service or admission.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-Practitioner"
},
"name" : "C4BB Practitioner",
"description" : "This profile builds upon the US Core Practitioner profile. It is used to convey information about the practitioner who provided to the patient services described on the claim.",
"exampleBoolean" : false,
"groupingId" : "profiles"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBPractitionerIdentifierType"
},
"name" : "C4BB Practitioner Identifier Type Value Set",
"description" : "Identifies the type of identifiers for practitioners",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBProfessionalAndNonClinicianClaimSubType"
},
"name" : "C4BB Professional And Non Clinician Claim SubType Value Set",
"description" : "This value set includes Professional and Non Clinician Claim SubType codes.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBProfessionalAndNonClinicianClaimType"
},
"name" : "C4BB Professional And Non Clinician Claim Type Value Set",
"description" : "This value set includes Professional and Non Clinician Claim Type codes.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBRelatedClaimRelationshipCodes"
},
"name" : "C4BB Related Claim Relationship Code System",
"description" : "Identifies if the current claim represents a claim that has been adjusted and was given a prior claim number or if the current claim has been adjusted; i.e., replaced by or merged to another claim number.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBRelatedClaimRelationshipCodes"
},
"name" : "C4BB Related Claim Relationship Codes Value Set",
"description" : "Identifies if the current claim represents a claim that has been adjusted and was given a prior claim number or if the current claim has been adjusted; i.e., replaced by or merged to another claim number.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "StructureDefinition:resource"
}
],
"reference" : {
"reference" : "StructureDefinition/C4BB-RelatedPerson"
},
"name" : "C4BB RelatedPerson",
"description" : "This profile is used to convey basic demographic information about a person related to the claim.",
"exampleBoolean" : false,
"groupingId" : "profiles"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "CodeSystem"
}
],
"reference" : {
"reference" : "CodeSystem/C4BBSupportingInfoType"
},
"name" : "C4BB Supporting Info Type Code System",
"description" : "Claim Information Category - Used as the discriminator for supportingInfo.\n\nThis is a code system defined locally by the CARIN BlueButton IG. As this IG matures, it is expected that this CodeSystem will be migrated to THO (terminology.hl7.org). The current CodeSystem url should be considered temporary and subject to change in a future version.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBSupportingInfoType"
},
"name" : "C4BB SupportingInfo Type Value Set",
"description" : "Used as the discriminator for the types of supporting information for the CARIN IG for Blue Button� Implementation Guide.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBTotalCategoryDiscriminator"
},
"name" : "C4BB Total Category Discriminator Value Set",
"description" : "Used as the discriminator for total.category for the CARIN IG for Blue Button®",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBTransportationServiceCategories"
},
"name" : "C4BB Transportation Services Categories Value Set",
"description" : "Transportation Services Supporting Info Category Codes",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/CMSPlaceofServiceCodes"
},
"name" : "CMS Place of Service Codes (POS) Value Set",
"description" : "Place of Service Codes are two-digit codes placed on health care professional claims to indicate the setting in which a service was provided. The Centers for Medicare & Medicaid Services (CMS) maintain POS codes used throughout the health care industry.\n\nThis code set is required for use in the implementation guide adopted as the national standard for electronic transmission of professional health care claims under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA directed the Secretary of HHS to adopt national standards for electronic transactions. These standard transactions require all health plans and providers to use standard code sets to populate data elements in each transaction. The Transaction and Code Set Rule adopted the ASC X12N-837 Health Care Claim: Professional, volumes 1 and 2, as the standard for electronic submission of professional claims. This standard names the POS code set currently maintained by CMS as the code set to be used for describing sites of service in such claims. POS information is often needed to determine the acceptability of direct billing of Medicare, Medicaid and private insurance services provided by a given provider.\n\nCurrent codes can be obtained [here](https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/CMSPresentOnAdmissionIndicator"
},
"name" : "CMS Present On Admission Indicator Codes Value Set",
"description" : "This code system consists of Present on Admission (POA) indicators which are assigned to the principal and secondary diagnoses (as defined in Section II of the Official Guidelines for Coding and Reporting) and the external cause of injury codes to indicate the presence or absence of the diagnosis at the time of inpatient admission.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Coverage"
}
],
"reference" : {
"reference" : "Coverage/Coverage1"
},
"name" : "Coverage Example 1",
"description" : "Coverage Example1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Coverage"
}
],
"reference" : {
"reference" : "Coverage/Coverage2"
},
"name" : "Coverage Example 2",
"description" : "Coverage Example 2",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Coverage"
}
],
"reference" : {
"reference" : "Coverage/Coverage3"
},
"name" : "Coverage Example 3",
"description" : "Coverage Example 3",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/coverage-payor"
},
"name" : "Coverage_Payor",
"description" : "The identity of the insurer or party paying for services",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Coverage"
}
],
"reference" : {
"reference" : "Coverage/CoverageDental1"
},
"name" : "Dental Coverage Example1",
"description" : "Dental Coverage Example1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/DentalPayer1"
},
"name" : "Dental Payer1",
"description" : "Dental Payer1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Practitioner"
}
],
"reference" : {
"reference" : "Practitioner/PractitionerDentalProvider1"
},
"name" : "Dental Provider 1",
"description" : "Dental Provider 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/CDCICD910CMDiagnosisCodes"
},
"name" : "Diagnosis Codes - International Classification of Diseases, Clinical Modification (ICD-9-CM, ICD-10-CM) Value Set",
"description" : "The Value Set is a combination of values from volume 1 and volume 2 from the Code System International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and values in the Code System International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)\n\nThe International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is based on the World Health Organization’s Ninth Revision, International Classification of Diseases (ICD-9). ICD-9-CM was the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States.\n\nThe ICD-9-CM consists of:\n\n* a tabular list containing a numerical list of the disease code numbers in tabular form;\n* an alphabetical index to the disease entries; and\n* a classification system for surgical, diagnostic, and therapeutic procedures (alphabetic index and tabular list).\n\nThe National Center for Health Statistics (NCHS) and the [Centers for Medicare and Medicaid Services](http://www.cms.hhs.gov/) are the U.S. governmental agencies responsible for overseeing all changes and modifications to the ICD-9-CM.\n\n[ICD-10-CM](https://confluence.hl7.org/pages/viewpage.action?pageId=97453674) is the replacement for ICD-9-CM, volumes 1 and 2, effective October 1, 2015.\n\nThe National Center for Health Statistics (NCHS), the Federal agency responsible for use of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) in the United States, has developed a clinical modification of the classification for morbidity purposes. The ICD-10 is used to code and classify mortality data from death certificates, having replaced ICD-9 for this purpose as of January 1, 1999.\n\nThe clinical modification represents a significant improvement over ICD-9-CM and ICD-10. Specific improvements include: the addition of information relevant to ambulatory and managed care encounters; expanded injury codes; the creation of combination diagnosis/symptom codes to reduce the number of codes needed to fully describe a condition; the addition of sixth and seventh characters; incorporation of common 4th and 5th digit subclassifications; laterality; and greater specificity in code assignment. The new structure will allow further expansion than was possible with ICD-9-CM.\n\nCurrent and previous releases of ICD-9-CM are available here: [https://www.cdc.gov/nchs/icd/icd9cm.htm](https://www.cdc.gov/nchs/icd/icd9cm.htm)\n\nCurrent and previous releases of ICD-10-CM are available in PDF and XML format here: [https://www.cdc.gov/nchs/icd/icd10cm.htm](https://www.cdc.gov/nchs/icd/icd10cm.htm)\n\nMost files are provided in compressed zip format for ease in downloading. These files have been created by the National Center for Health Statistics (NCHS), under authorization by the World Health Organization. Any questions regarding typographical or other errors noted on this release may be reported to nchsicd10cm@cdc.gov.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/EOBInpatient2"
},
"name" : "EOB Inpatient Example 2",
"description" : "EOB Inpatient Example 2",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/EOBInpatient1"
},
"name" : "EOB Inpatient Example1",
"description" : "EOB Inpatient Example 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/BB-EOBInpatient1-nonfinancial"
},
"name" : "EOB Inpatient Institutional - Example 1 - Nonfinancial",
"description" : "EOB Inpatient Institutional - Example 1 - Nonfinancial",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional-Basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/BB-EOBInpatient2-nonfinancial"
},
"name" : "EOB Inpatient Institutional - Example 2 - Nonfinancial",
"description" : "EOB Inpatient Institutional - Example 2 - Nonfinancial",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional-Basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/EOBOral1"
},
"name" : "EOB Oral Example 1",
"description" : "EOB Oral Example 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/EOBOral2"
},
"name" : "EOB Oral Example 2",
"description" : "EOB Oral Example 2",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/EOBOutpatient1"
},
"name" : "EOB Outpatient Institutional - Example 1",
"description" : "EOB Outpatient Institutional - Example 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/BB-EOBOutpatient1-nonfinancial"
},
"name" : "EOB Outpatient Institutional - Example 1 - Nonfinancial",
"description" : "EOB Outpatient Institutional - Example 1 - Nonfinancial",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/EOBOutpatient2"
},
"name" : "EOB Outpatient Institutional - Example 2",
"description" : "EOB Outpatient Institutional - Example 2",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/BB-EOBOutpatient2-nonfinancial"
},
"name" : "EOB Outpatient Institutional - Example 2 - Nonfinancial",
"description" : "EOB Outpatient Institutional - Example 2 - Nonfinancial",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/EOBPharmacy1"
},
"name" : "EOB Pharmacy Example1",
"description" : "EOB Pharmacy Example1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/EOBProfessional1"
},
"name" : "EOB Professional - Example 1",
"description" : "EOB Professional - Example 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/BB-EOBProfessional1-nonfinancial"
},
"name" : "EOB Professional - Example 1 - Nonfinancial",
"description" : "EOB Professional Example 1 - Nonfinancial",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician-Basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/EOBProfessional2"
},
"name" : "EOB Professional - Example 2",
"description" : "EOB Professional - Example 2",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/BB-EOBProfessional2-nonfinancial"
},
"name" : "EOB Professional - Example 2 - Nonfinancial",
"description" : "EOB Professional - Example 2 - Nonfinancial",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician-Basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/EOBProfessionalTransportation1"
},
"name" : "EOB Professional - Transportation 1",
"description" : "EOB Professional - Transportation 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ExplanationOfBenefit"
}
],
"reference" : {
"reference" : "ExplanationOfBenefit/BB-EOBProfessionalTransportation1-nonfinancial"
},
"name" : "EOB Professional - Transportation 1 - Nonfinancial",
"description" : "EOB Professional - Transportation Services Example 1 - Nonfinancial",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician-Basis"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-billable-period-start"
},
"name" : "ExplanationOfBenefit_BillablePeriodStart",
"description" : "Starting Date of the service for the EOB using billablePeriod.period.start. The billable-period-start search parameter using the billablePeriod.period.start provides results with the earliest billablePeriod.start from a professional and non-clinician EOB or an oral EOB.",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-care-team"
},
"name" : "ExplanationOfBenefit_Careteam",
"description" : "Member of the CareTeam",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-coverage"
},
"name" : "ExplanationOfBenefit_Coverage",
"description" : "The plan under which the claim was adjudicated",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-identifier"
},
"name" : "ExplanationOfBenefit_Identifier",
"description" : "The business/claim identifier of the Explanation of Benefit",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-insurer"
},
"name" : "ExplanationOfBenefit_Insurer",
"description" : "The party responsible for the claim",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/practitionerrole-organization"
},
"name" : "ExplanationOfBenefit_Organization",
"description" : "The identity of the organization the practitioner represents / acts on behalf of",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-patient"
},
"name" : "ExplanationOfBenefit_Patient",
"description" : "The reference to the patient",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/practitionerrole-practitioner"
},
"name" : "ExplanationOfBenefit_Practitioner",
"description" : "Practitioner that is able to provide the defined services for the organization",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-provider"
},
"name" : "ExplanationOfBenefit_Provider",
"description" : "The reference to the provider",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-service-date"
},
"name" : "ExplanationOfBenefit_ServiceDate",
"description" : "The service-date search parameter is meant to simplify the search for the client enabling them to use one search parameter across EoB types for the service date. With this parameter. the client doesn't need to know that for inpatient and outpatient institutional EOB dates they need to search by billablePeriod, for a pharmacy EOB by item.servicedDate, for a professional and non-clinician EOB - by item.servicedPeriod and for an oral EOB – by item.servicedPeriod.",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-service-start-date"
},
"name" : "ExplanationOfBenefit_ServiceStartDate",
"description" : "Starting Date of the service for the EOB. The service-start-date search parameter simplifies search, since a client doesn't need to know that for inpatient and outpatient institutional EOB dates they need to search by billablePeriod.start, for a pharmacy EOB by item.servicedDate, for a professional and non-clinician EOB - by item.servicedPeriod.start and for an oral EOB – by item.servicedPeriod.start.",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "SearchParameter"
}
],
"reference" : {
"reference" : "SearchParameter/explanationofbenefit-type"
},
"name" : "ExplanationOfBenefit_Type",
"description" : "The type of the ExplanationOfBenefit",
"exampleBoolean" : false,
"groupingId" : "search"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/CMSMS3MAPAPRDRG"
},
"name" : "MS-DRGs - AP-DRGs - APR-DRGs Value Set",
"description" : "This value set defines three sets of DRGs, MS-DRGs (Medicare Severity Diagnosis Related Groups), APR-DRGs (All Patient Refined Diagnosis Related Groups) and AP-DRGs (All Patient Diagnosis Related Groups). Identifying a DRG code requires a version.\n\n**MS-DRGs**\n\nSection 1886(d) of the Act specifies that the Secretary shall establish a classification system (referred to as DRGs) for inpatient discharges and adjust payments under the IPPS based on appropriate weighting factors assigned to each DRG. Therefore, under the IPPS, we[CMS] pay for inpatient hospital services on a rate per discharge basis that varies according to the DRG to which a beneficiary's stay is assigned. The formula used to calculate payment for a specific case multiplies an individual hospital's payment rate per case by the weight of the DRG to which the case is assigned. Each DRG weight represents the average resources required to care for cases in that particular DRG, relative to the average resources used to treat cases in all DRGs.\n\nCongress recognized that it would be necessary to recalculate the DRG relative weights periodically to account for changes in resource consumption. Accordingly, section 1886(d)(4)(C) of the Act requires that the Secretary adjust the DRG classifications and relative weights at least annually. These adjustments are made to reflect changes in treatment patterns, technology, and any other factors that may change the relative use of hospital resources.\n\nCurrently, cases are classified into Medicare Severity Diagnosis Related Groups (MS-DRGs) for payment under the IPPS based on the following information reported by the hospital: the principal diagnosis, up to 25 additional diagnoses, and up to 25 procedures performed during the stay. In a small number of MS-DRGs, classification is also based on the age, sex, and discharge status of the patient. Effective October 1, 2015, the diagnosis and procedure information is reported by the hospital using codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).\n\nContent can be obtained on the CMS hosted page located [here](https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software)\n\n**APR-DRGs**\n\n3M APR DRGs have become the standard across the U.S. for classifying hospital inpatients in non-Medicare populations. As of January 2019, 27 state Medicaid programs use 3M APR DRGs to pay hospitals, as do approximately a dozen commercial payers and Medicaid managed care organizations. Over 2,400 hospitals have licensed 3M APR DRGs to verify payment and analyze their internal operations.\n\nThe 3M APR DRG methodology classifies hospital inpatients according to their reason for admission, severity of illness and risk of mortality.\n\nEach year 3M calculates and releases a set of statistics for each 3M APR DRG based on our analysis of large national data sets. These statistics include a relative weight for each 3M APR DRG. The relative weight reflects the average hospital resource use for a patient in that 3M APR DRG relative to the average hospital resource use of all inpatients. Please note that payers and other users of the 3M APR DRG methodology are responsible for ensuring that they use relative weights that are appropriate for their particular populations. The 3M APR DRG statistics also include data for each 3M APR DRG on relative frequency, average length of stay, average charges and incidence of mortality.\n\n3M APR DRGs can be rolled up into broader categories. The 326 base DRGs roll up into 25 major diagnostic categories (MDCs) plus a pre-MDC category. An example is MDC 04, Diseases and Disorders of the Respiratory System. As well, each 3M APR DRG is assigned to a service line that is consistent with the outpatient service lines that are defined by the 3Mâ„¢ Enhanced Ambulatory Patient Groups (EAPGs).\n\nLink to information about the code system - including how to obtain the content from 3M - is available [here.](https://www.3m.com/3M/en_US/health-information-systems-us/drive-value-based-care/patient-classification-methodologies/apr-drgs/).\n\n**AP-DRGs**\n\nIn 1987, the state of New York passed legislation instituting a DRG-based prospective payment system for all non-Medicare patients. The legislation included a requirement that the New York State Department of Health (NYDH) evaluate the applicability of the DRGs to a non-Medicare population. In particular, the legislation required that the DRGs be evaluated with respect to neonates and patients with Human Immunodeficiency Virus (HIV) infections. NYDH entered into an agreement with 3M HIS to assist with the evaluation of the need for DRG modifications as well as to make the necessary changes in the DRG definitions and software. The DRG definitions developed by NYDH and 3M HIS are referred to as the All Patient DRGs (AP DRGs).\n\nThe AP DRG code system is no longer updated as DRG classification system evolved to APR DRG. Evolution of DRG is summarized in the APR DRG methodology overview as well as in various articles.\n\n\nGoldfield N. The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital. Qual Manage Health Care. 2010;19(1)3-16.\n\n\nAverill RF, Goldfield NI, Muldoon J, Steinbeck BA, Grant TM. A closer look at All-Patient Refined DRGs. J AHIMA. 2002;73(1):46-49.\n\n[https://apps.3mhis.com/docs/Groupers/All\\_Patient\\_Refined\\_DRG/Methodology\\_overview\\_GRP041/grp041\\_aprdrg\\_meth\\_overview.pdf](https://apps.3mhis.com/docs/Groupers/All_Patient_Refined_DRG/Methodology_overview_GRP041/grp041_aprdrg_meth_overview.pdf)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/FDANationalDrugCode"
},
"name" : "National Drug Code (NDC) Value Set",
"description" : "The Drug Listing Act of 1972 requires registered drug establishments to provide the Food and Drug Administration (FDA) with a current list of all drugs manufactured, prepared, propagated, compounded, or processed by it for commercial distribution. (See Section 510 of the Federal Food, Drug, and Cosmetic Act (Act) (21 U.S.C. § 360)). Drug products are identified and reported using a unique, three-segment number, called the National Drug Code (NDC), which serves as a universal product identifier for drugs. FDA publishes the listed NDC numbers and the information submitted as part of the listing information in the NDC Directory which is updated daily.\n\nThe information submitted as part of the listing process, the NDC number, and the NDC Directory are used in the implementation and enforcement of the Act.\n\nUsers should note:\n\nStarting June 1, 2011, only drugs for which electronic listings (SPL) have been submitted to FDA are included in the NDC Directory. Drugs for which listing information was last submitted to FDA on paper forms, prior to June 2009, are included on a separate file and will not be updated after June 2012.\n\nInformation regarding the FDA published NDC Directory can be found [here](https://www.fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory)\n\nUsers should note a few important items\n\n* The NDC Directory is updated daily.\n* The new NDC Directory contains ONLY information on final marketed drugs submitted to FDA in SPL electronic listing files by labelers.\n* The NDC Directory does not contain all listed drugs. The new version includes the final marketed drugs which listing information were submitted electronically. It does not include animal drugs, blood products, or human drugs that are not in final marketed form, such as Active Pharmaceutical Ingredients(APIs), drugs for further processing, drugs manufactured exclusively for a private label distributor, or drugs that are marketed solely as part of a kit or combination product or inner layer of a multi-level packaged product not marketed individually. For more information about how certain kits or multi-level packaged drugs are addressed in the new NDC Directory, see the NDC Directory Package File definitions document. For the FDA Online Label Repository page and additional resources go to: [FDA Online Label Repository](https://labels.fda.gov/)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/NCPDPBrandGenericIndicator"
},
"name" : "NCPDP Brand Generic Indicator Value Set",
"description" : "Denotes brand or generic drug dispensed. (NCPDP ECL 686)\n\nLink to information about the code system - including how to obtain the content: [https://standards.ncpdp.org/Access-to-Standards.aspx](https://standards.ncpdp.org/Access-to-Standards.aspx)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/NCPDPCompoundCode"
},
"name" : "NCPDP Compound Code Value Set",
"description" : "Code indicating whether or not the prescription is a compound. (NCPDP ECL 406-D6)\n\nLink to information about the code system - including how to obtain the content: [https://standards.ncpdp.org/Access-to-Standards.aspx](https://standards.ncpdp.org/Access-to-Standards.aspx)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/NCPDPDispensedAsWrittenOrProductSelectionCode"
},
"name" : "NCPDP Dispense As Written (DAW)/Product Selection Code Value Set",
"description" : "Code indicating whether or not the prescriber's instructions regarding generic substitution were followed. (NCPDP ECL 408-D8)\n\nLink to information about the code system - including how to obtain the content: [https://standards.ncpdp.org/Access-to-Standards.aspx](https://standards.ncpdp.org/Access-to-Standards.aspx)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/NCPDPPrescriptionOriginCode"
},
"name" : "NCPDP Prescription Origin Code Value Set",
"description" : "Code indicating the origin of the prescription. Indicates whether the prescription was transmitted as an electronic prescription, by phone, by fax, or as a written paper copy. (NCPDP ECL 419-DJ)\n\nLink to information about the code system - including how to obtain the content: [https://standards.ncpdp.org/Access-to-Standards.aspx](https://standards.ncpdp.org/Access-to-Standards.aspx)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/NCPDPRejectCode"
},
"name" : "NCPDP Reject Code Value Set",
"description" : "Code indicating the error encountered. Contains exception definitions for use when transaction processing cannot be completed. (NCPDP ECL 511-FB).\n\nLink to information about the code system - including how to obtain the content: [https://standards.ncpdp.org/Access-to-Standards.aspx](https://standards.ncpdp.org/Access-to-Standards.aspx)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/FDANDCOrCompound"
},
"name" : "NDC or Compound Value Set",
"description" : "Values will be the NDC Codes when the Compound Code value is 0 or 1. When the Compound Code value = 2, the value will be the literal, ‘compound’",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/AHANUBCPatientDischargeStatus"
},
"name" : "NUBC Patient Discharge Status Codes Value Set",
"description" : "The UB-04 Data File contains the complete set of NUBC codes. Every code in the range of possible codes is accounted for sequentially. There are no gaps because all used and unused codes are identified.\n\nThis code system consists of the following:\n\n* FL 17 - Patient Discharge Status\n\nThese codes are used to convey the patient discharge status and are the property of the American Hospital Association.\n\nTo obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/AHANUBCPointOfOriginForAdmissionOrVisit"
},
"name" : "NUBC Point Of Origin Value Set",
"description" : "The UB-04 Data File contains the complete set of NUBC codes. Every code in the range of possible codes is accounted for sequentially. There are no gaps because all used and unused codes are identified.\n\nThis code system consists of the following:\n\n* FL 15 - Point of Origin for Admission or Visit\n\nThese codes are used to convey the patient point of origin for an admission or visit and are the property of the American Hospital Association\n\nTo obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/AHANUBCPriorityTypeOfAdmissionOrVisit"
},
"name" : "NUBC Priority (Type) of Admission or Visit Value Set",
"description" : "The UB-04 Data File contains the complete set of NUBC codes. Every code in the range of possible codes is accounted for sequentially. There are no gaps because all used and unused codes are identified.\n\nThis code system consists of the following:\n\n* FL 14 - Priority (Type) of Admission or Visit\n\nThese codes are used to convey the priority of an admission or visit and are the property of the American Hospital Association.\n\nTo obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/AHANUBCRevenueCodes"
},
"name" : "NUBC Revenue Codes Value Set",
"description" : "The UB-04 Data File contains the complete set of NUBC codes. Every code in the range of possible codes is accounted for sequentially. There are no gaps because all used and unused codes are identified.\n\nThis code system consists of the following:\n\n* FL 42 - Revenue Codes\n\nThese codes are used to convey the revenue code and are the property of the American Hospital Association.\n\nTo obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/AHANUBCTypeOfBill"
},
"name" : "NUBC Type of Bill Codes Value Set",
"description" : "The UB-04 Data File contains the complete set of NUBC codes. Every code in the range of possible codes is accounted for sequentially. There are no gaps because all used and unused codes are identified.\n\nThis code system consists of the following:\n\n* FL 04 - Type of Bill Facility Codes\n* FL 04 - Type of Bill Frequency Codes\n\nA code indicating the specific Type of Bill (TOB), e.g., hospital inpatient, outpatient, replacements, voids, etc. The first digit is a leading zero\\*. The fourth digit defines the frequency of the bill for the institutional and electronic professional claim.\n\nNote that with the advent of UB-04, the matrix methodology of constructing the first component of TOB codes according to digit position was abandoned in favor of specifying valid discrete codes. As a result, the first three digits in TOB have no underlying meaning.\n\nTo obtain the underlying code systems, please see information [here](https://www.nubc.org/subscription-information)",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/OralBodySite"
},
"name" : "Oral Body Site Value Set",
"description" : "Oral Body Site indicating tooth numbers and area of oral cavity.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Patient"
}
],
"reference" : {
"reference" : "Patient/Patient1"
},
"name" : "Patient Example 1",
"description" : "Patient Example 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Patient"
}
],
"reference" : {
"reference" : "Patient/Patient2"
},
"name" : "Patient Example 2",
"description" : "Patient Example 2",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/Payer1"
},
"name" : "Payer 1",
"description" : "Payer 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/Payer2"
},
"name" : "Payer 2",
"description" : "Payer 2",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Practitioner"
}
],
"reference" : {
"reference" : "Practitioner/Practitioner1"
},
"name" : "Practitioner Example 1",
"description" : "Practitioner Example 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Practitioner"
}
],
"reference" : {
"reference" : "Practitioner/Practitioner2"
},
"name" : "Practitioner Example 2",
"description" : "Practitioner Example 2",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Practitioner"
}
],
"reference" : {
"reference" : "Practitioner/Practitioner3"
},
"name" : "Practitioner Example 3",
"description" : "Practitioner Example 3",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Practitioner"
}
],
"reference" : {
"reference" : "Practitioner/Practitioner4"
},
"name" : "Practitioner4",
"description" : "Practitioner 4",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBEOBInstitutionalProcedureCodes"
},
"name" : "Procedure Codes - AMA CPT - CMS HCPCS - CMS HIPPS Value Set",
"description" : "The Value Set is a combination of three Code Systems: CPT (HCPCS I), HCPCS II procedure codes, and HIPPS rate codes. They are submitted by providers to payers to convey the specific procedure performed. Procedure Codes leverage US Core Procedure Codes composition.\n\nThe target set for this value set are the procedure codes from the CPT and HCPCS files and the rate codes from the HIPPS files.\n\nThe Current Procedural Terminology (CPT) code set, created and maintained by the American Medical Association, is the language of medicine today and the code to its future. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT coding is also used for administrative management purposes such as claims processing and developing guidelines for medical care review. Each year, via a rigorous, evidence-based and transparent process, the independent CPT Editorial Panel revises, creates or deletes hundreds of codes in order to reflect current medical practice.\n\nDesignated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services.\n\nAll CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm.\n\nThere are various types of CPT codes:\n\n**Category I:** These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy.\n\n**Category II:** These alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding.\n\n**Category III:** These are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code.\n\n**Proprietary Laboratory Analyses (PLA) codes:** Recently added to the CPT code set, these codes describe proprietary clinical laboratory analyses and can be either provided by a single (solesource) laboratory or licensed or marketed to multiple providing laboratories that are cleared or approved by the Food and Drug Administration (FDA)). This category includes but is not limited to Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA).\n\nTo obtain CPT, please see the license request form [here](http://info.commerce.ama-assn.org/ama-data-file-request-2020)\n\nThe Level II HCPCS codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4 (CPT-4) codes; Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing. Level II alphanumeric procedure and modifier codes comprise the A to V range.\n\nGeneral information can be found here: [https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo](https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo)\n\nReleases can be found here: [https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets](https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets)\n\nThese files contain the Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage and pricing data.\n\nThe Health Insurance Prospective Payment System (HIPPS) rate codes represent specific sets\nof patient characteristics (or case-mix groups) health insurers use to make payment\ndeterminations under several prospective payment systems. Case-mix groups are\ndeveloped based on research into utilization patterns among various provider types. For\nthe payment systems that use HIPPS codes, clinical assessment data is the basic input. A\nstandard patient assessment instrument is interpreted by case-mix grouping software\nalgorithms, which assign the case mix group. For payment purposes, at least one HIPPS\ncode is defined to represent each case-mix group. These HIPPS codes are reported on\nclaims to insurers.\nInstitutional providers use HIPPS codes on claims in association with special revenue\ncodes. One revenue code is defined for each prospective payment system that requires\nHIPPS codes. HIPPS codes are placed in data element SV202 on the electronic 837\ninstitutional claims transaction, using an HP qualifier, or in Form Locator (FL) 44\n(\"HCPCS/rate\") on a paper UB-04 claims form. The associated revenue code is placed in\ndata element SV201 or in FL 42. In certain circumstances, multiple HIPPS codes may\nappear on separate lines of a single claim.\n\nHIPPS codes are alpha-numeric codes of five digits. Each code contains intelligence,\nwith certain positions of the code indicating the case mix group itself, and other positions\nproviding additional information. The additional information varies among HIPPS codes\npertaining to different payment systems, but often provides information about the clinical\nassessment used to arrive at the code. Which positions of the code carry the case mix\ngroup information may also vary by payment systems.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/AMACPTCMSHCPCSProcedureCodes"
},
"name" : "Procedure Codes - AMA CPT - CMS HCPCS Value Set",
"description" : "The Value Set is a combination of two Code Systems: CPT (HCPCS I) and HCPCS II procedure codes. They are submitted by providers to payers to convey the specific procedure performed. Procedure Codes leverage US Core Procedure Codes composition.\n\nThe target set for this value set are the procedure codes from the CPT and HCPCS files.\n\nThe Current Procedural Terminology (CPT) code set, created and maintained by the American Medical Association, is the language of medicine today and the code to its future. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT coding is also used for administrative management purposes such as claims processing and developing guidelines for medical care review. Each year, via a rigorous, evidence-based and transparent process, the independent CPT Editorial Panel revises, creates or deletes hundreds of codes in order to reflect current medical practice.\n\nDesignated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services.\n\nAll CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm.\n\nThere are various types of CPT codes:\n\n**Category I:** These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy.\n\n**Category II:** These alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding.\n\n**Category III:** These are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code.\n\n**Proprietary Laboratory Analyses (PLA) codes:** Recently added to the CPT code set, these codes describe proprietary clinical laboratory analyses and can be either provided by a single (solesource) laboratory or licensed or marketed to multiple providing laboratories that are cleared or approved by the Food and Drug Administration (FDA)). This category includes but is not limited to Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA).\n\nTo obtain CPT, please see the license request form [here](http://info.commerce.ama-assn.org/ama-data-file-request-2020)\n\nThe Level II HCPCS codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4 (CPT-4) codes; Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing. Level II alphanumeric procedure and modifier codes comprise the A to V range.\n\nGeneral information can be found here: [https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo](https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo)\n\nReleases can be found here: [https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets](https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets)\n\nThese files contain the Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage and pricing data.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/CMSICD910PCSProcedureCodes"
},
"name" : "Procedure Codes - International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) - ICD-10 Procedure Value Set",
"description" : "The Value Set is a combination of values from volume 3 from the Code System International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and values in the Code System ICD-10 Procedure Coding System.\n\nThe International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) is based on the World Health Organization’s Ninth Revision, International Classification of Diseases (ICD-9). ICD-9-CM was the official system of assigning codes to diagnoses and procedures associated with hospital utilization in the United States.\n\nThe ICD-9-CM consists of:\n\n* a tabular list containing a numerical list of the disease code numbers in tabular form;\n* an alphabetical index to the disease entries; and\n* a classification system for surgical, diagnostic, and therapeutic procedures (alphabetic index and tabular list).\n\nThe National Center for Health Statistics (NCHS) and the [Centers for Medicare and Medicaid Services](http://www.cms.hhs.gov/) are the U.S. governmental agencies responsible for overseeing all changes and modifications to the ICD-9-CM.\n\nThe ICD-10-PCS is the replacement for ICD-9-CM, volume 3, effective October 1, 2015.\n\nThe ICD-10-PCS is a procedure classification published by the United States Centers for Medicare & Medicaid Services (CMS) ([https://www.cms.gov](https://www.cms.gov/)) for classifying procedures\nperformed in hospital inpatient health care settings.\n\nCurrent and previous releases of ICD-9-CM are available here: [https://www.cdc.gov/nchs/icd/icd9cm.htm](https://www.cdc.gov/nchs/icd/icd9cm.htm)\n\nMost files are provided in compressed zip format for ease in downloading. These files have been created by the National Center for Health Statistics (NCHS), under authorization by the World Health Organization. Any questions regarding typographical or other errors noted on this release may be reported to [nchsicd10cm@cdc.gov](mailto:nchsicd10cm@cdc.gov).\n\nA link to information about the ICD-10-PCS code system - including how to obtain the content - is available at [https://www.cms.gov/Medicare/Coding/ICD10.](https://www.cms.gov/Medicare/Coding/ICD10)\n\nNote: CMS is the owner of the ICD-10-PCS code system. CMS is NOT the owner of ICD-10-CM. CMS republishes the ICD-10-CM codes system on their website for convenience only. For authoritative information on ICD-10-CM, users should refer to the National Center for Health Statistics (NCHS) site located [here](https://www.cdc.gov/nchs/icd/icd10cm.htm).",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/AMACPTCMSHCPCSModifiers"
},
"name" : "Procedure Modifier Codes - AMA CPT - CMS HCPCS Value Set",
"description" : "The Value Set is a combination of two Code Systems: CPT (HCPCS I) and HCPCS II procedure code modifiers. Modifiers help further describe a procedure code without changing its definition.\n\nThe target set for this value set are the procedure code modifiers from the CPT and HCPCS files.\n\nThe Current Procedural Terminology (CPT) code set, created and maintained by the American Medical Association, is the language of medicine today and the code to its future. This system of terminology is the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT coding is also used for administrative management purposes such as claims processing and developing guidelines for medical care review. Each year, via a rigorous, evidence-based and transparent process, the independent CPT Editorial Panel revises, creates or deletes hundreds of codes in order to reflect current medical practice.\n\nDesignated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) as a national coding set for physician and other health care professional services and procedures, CPT’s evidence-based codes accurately encompass the full range of health care services.\n\nAll CPT codes are five-digits and can be either numeric or alphanumeric, depending on the category. CPT code descriptors are clinically focused and utilize common standards so that a diverse set of users can have common understanding across the clinical health care paradigm.\n\nThere are various types of CPT codes:\n\n**Category I:** These codes have descriptors that correspond to a procedure or service. Codes range from 00100–99499 and are generally ordered into sub-categories based on procedure/service type and anatomy.\n\n**Category II:** These alphanumeric tracking codes are supplemental codes used for performance measurement. Using them is optional and not required for correct coding.\n\n**Category III:** These are temporary alphanumeric codes for new and developing technology, procedures and services. They were created for data collection, assessment and in some instances, payment of new services and procedures that currently don’t meet the criteria for a Category I code.\n\n**Proprietary Laboratory Analyses (PLA) codes:** Recently added to the CPT code set, these codes describe proprietary clinical laboratory analyses and can be either provided by a single (solesource) laboratory or licensed or marketed to multiple providing laboratories that are cleared or approved by the Food and Drug Administration (FDA)). This category includes but is not limited to Advanced Diagnostic Laboratory Tests (ADLTs) and Clinical Diagnostic Laboratory Tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA).\n\nTo obtain CPT, please see the license request form [here](http://info.commerce.ama-assn.org/ama-data-file-request-2020)\n\nThe Level II HCPCS codes, which are established by CMS's Alpha-Numeric Editorial Panel, primarily represent items and supplies and non-physician services not covered by the American Medical Association's Current Procedural Terminology-4 (CPT-4) codes; Medicare, Medicaid, and private health insurers use HCPCS procedure and modifier codes for claims processing. Level II alphanumeric procedure and modifier codes comprise the A to V range.\n\nGeneral information can be found here: [https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo](https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo)\n\nReleases can be found here: [https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets](https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets)\n\nThese files contain the Level II alphanumeric HCPCS procedure and modifier codes, their long and short descriptions, and applicable Medicare administrative, coverage and pricing data.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/ProviderOrganization1"
},
"name" : "Provider Organization 1",
"description" : "Provider Organization 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/ProviderOrganization2"
},
"name" : "Provider Organization 2",
"description" : "Provider Organization 2",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/ProviderOrganization3"
},
"name" : "Provider Organization 3",
"description" : "Provider Organization 3",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/ProviderOrganization4"
},
"name" : "Provider Organization 4",
"description" : "Provider Organization 4",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/ProviderOrganization5"
},
"name" : "Provider Organization 5",
"description" : "Provider Organization 5",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/ProviderOrganization6"
},
"name" : "Provider Organization 6",
"description" : "Provider Organization 6",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "Organization"
}
],
"reference" : {
"reference" : "Organization/ProviderTransportationOrganization1"
},
"name" : "Provider Transportation Organization Example 1",
"description" : "Provider Transportation Organization Example 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "RelatedPerson"
}
],
"reference" : {
"reference" : "RelatedPerson/RelatedPerson1"
},
"name" : "Related Person 1",
"description" : "Related Person 1",
"exampleCanonical" : "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-RelatedPerson"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/C4BBSurfaceCodes"
},
"name" : "US Surface Codes Set Value Set",
"description" : "This value set includes FDI tooth surface codes localized for the US Realm.",
"exampleBoolean" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString" : "ValueSet"
}
],
"reference" : {
"reference" : "ValueSet/X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes"
},
"name" : "X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes Value Set",
"description" : "X12, chartered by the American National Standards Institute for more than 40 years, develops and maintains EDI standards and XML schemas which drive business processes globally. X12's diverse membership includes technologists and business process experts in health care, insurance, transportation, finance, government, supply chain and other industries.\n\nThe X12 Claim Adjustment Reason Codes describe why a claim or service line was paid differently than it was billed. These codes are listed within an X12 implementation guide (TR3) and maintained by X12.\n\nRemittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing.\n\nEach RARC identifies a specific message as shown in the Remittance Advice Remark Code List. There are two types of RARCs, supplemental and informational. The majority of the RARCs are supplemental; these are generally referred to as RARCs without further distinction. Supplemental RARCs provide additional explanation for an adjustment already described by a CARC. The second type of RARC is informational; these RARCs are all prefaced with Alert: and are often referred to as Alerts. Alerts are used to convey information about remittance processing and are never related to a specific adjustment or CARC.\n\nExternal code lists maintained by X12 and external code lists maintained by others and distributed by WPC on behalf of the maintainer can be found here:\n\n[https://x12.org/codes](https://x12.org/codes)\n\nClick on the name of any external code list to access more information about the code list, view the codes, or submit a maintenance request. These external code lists were previously published on either [www.wpc-edi.com/reference](http://www.wpc-edi.com/reference) or [www.x12.org/codes](http://www.x12.org/codes).",
"exampleBoolean" : false
}
],
"page" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "toc.html"
}
],
"nameUrl" : "toc.html",
"title" : "Table of Contents",
"generation" : "html",
"page" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "index.html"
}
],
"nameUrl" : "index.html",
"title" : "Home",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "Background.html"
}
],
"nameUrl" : "Background.html",
"title" : "Background",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "Use_Case.html"
}
],
"nameUrl" : "Use_Case.html",
"title" : "Use Case",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "Conformance_Requirements.html"
}
],
"nameUrl" : "Conformance_Requirements.html",
"title" : "Conformance Requirements",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "General_Guidance.html"
}
],
"nameUrl" : "General_Guidance.html",
"title" : "General Guidance",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "Common_Payer_Consumer_Data_Set.html"
}
],
"nameUrl" : "Common_Payer_Consumer_Data_Set.html",
"title" : "Common Payer Consumer Data Set (CPCDS)",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "Terminology_Licensure.html"
}
],
"nameUrl" : "Terminology_Licensure.html",
"title" : "Terminology Licensure",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "artifacts.html"
}
],
"nameUrl" : "artifacts.html",
"title" : "Artifacts Summary",
"generation" : "html"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "searchparameters.html"
}
],
"nameUrl" : "searchparameters.html",
"title" : "Search Parameters",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "Security_And_Privacy_Considerations.html"
}
],
"nameUrl" : "Security_And_Privacy_Considerations.html",
"title" : "Security and Privacy Considerations",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "downloads.html"
}
],
"nameUrl" : "downloads.html",
"title" : "Downloads",
"generation" : "markdown"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode" : "informative"
},
{
"url" : "http://hl7.org/fhir/tools/StructureDefinition/ig-page-name",
"valueUrl" : "change_notes.html"
}
],
"nameUrl" : "change_notes.html",
"title" : "Change Notes",
"generation" : "markdown"
}
]
},
"parameter" : [
{
"code" : "path-resource",
"value" : "input/capabilities"
},
{
"code" : "path-resource",
"value" : "input/examples"
},
{
"code" : "path-resource",
"value" : "input/extensions"
},
{
"code" : "path-resource",
"value" : "input/models"
},
{
"code" : "path-resource",
"value" : "input/operations"
},
{
"code" : "path-resource",
"value" : "input/profiles"
},
{
"code" : "path-resource",
"value" : "input/resources"
},
{
"code" : "path-resource",
"value" : "input/vocabulary"
},
{
"code" : "path-resource",
"value" : "input/maps"
},
{
"code" : "path-resource",
"value" : "input/testing"
},
{
"code" : "path-resource",
"value" : "input/history"
},
{
"code" : "path-resource",
"value" : "fsh-generated/resources"
},
{
"code" : "path-pages",
"value" : "template/config"
},
{
"code" : "path-pages",
"value" : "input/images"
},
{
"code" : "path-tx-cache",
"value" : "input-cache/txcache"
}
]
}
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.