Explanation Of Benefits Profile Mapping Carin4BB
Supported Implementation Guides for FHIR-R4
ExplanationOfBenefit - FHIR v4.0.1 (hl7.org)
HL7.FHIR.US.CARIN-BB\C4BB ExplanationOfBenefit Inpatient Institutional - FHIR v4.0.1
HL7.FHIR.US.CARIN-BB\C4BB ExplanationOfBenefit Outpatient Institutional - FHIR v4.0.1
HL7.FHIR.US.CARIN-BB\C4BB ExplanationOfBenefit Pharmacy - FHIR v4.0.1
HL7.FHIR.US.CARIN-BB\C4BB ExplanationOfBenefit Professional NonClinician - FHIR v4.0.1
FHIR Elements to BSC Data Mapping
| FHIR Data Element |
| explanationOfBenefit.identifier[0].type.coding[0].system |
| explanationOfBenefit.identifier[0].type.coding[0].code |
| explanationOfBenefit.identifier[0].type.coding[0].display |
| explanationOfBenefit.identifier[0].type.text |
| explanationOfBenefit.identifier[0].system |
| explanationOfBenefit.identifier[0].code |
| explanationOfBenefit.type.coding[0].system |
| explanationOfBenefit.type.coding[0].code |
| explanationOfBenefit.meta.profile[0] |
| explanationOfBenefit.subType.coding[0].code |
| explanationOfBenefit.subType.coding[0].system |
| explanationOfBenefit.status |
| explanationOfBenefit.outcome |
| explanationOfBenefit.use |
| explanationOfBenefit.insurer.display |
| explanationOfBenefit.insurer.identifier.use |
| explanationOfBenefit.insurer.identifier.type.coding[0].system |
| explanationOfBenefit.insurer.identifier.type.coding[0].code |
| explanationOfBenefit.insurer.identifier.type.coding[0].userSelected |
| explanationOfBenefit.insurer.identifier.system |
| explanationOfBenefit.insurer.identifier.value |
| explanationOfBenefit.insurer.type |
| explanationOfBenefit.insurance[0].focal |
| explanationOfBenefit.insurance[0].coverage.reference |
| explanationOfBenefit.billablePeriod.start |
| explanationOfBenefit.billablePeriod.end |
| explanationOfBenefit.related.relationship.coding[0].system |
| explanationOfBenefit.related.relationship.coding[0].code |
| explanationOfBenefit.related.relationship.coding[0].display |
| explanationOfBenefit.related.relationship.text |
| explanationOfBenefit.related.reference.type.coding[0].system |
| explanationOfBenefit.related.reference.type.coding[0].code |
| explanationOfBenefit.related.relationship.coding[0].system |
| explanationOfBenefit.related.relationship.coding[0].code |
| explanationOfBenefit.related.relationship.coding[0].display |
| explanationOfBenefit.related.relationship.text |
| explanationOfBenefit.related.reference.type.coding[0].system |
| explanationOfBenefit.related.reference.type.coding[0].code |
| explanationOfBenefit.patient.reference |
| explanationOfBenefit.provider.display |
| explanationOfBenefit.provider.identifier.use |
| explanationOfBenefit.provider.identifier.type.coding[0].system |
| explanationOfBenefit. provider.identifier.type.coding[0].code |
| explanationOfBenefit.provider.identifier.type.coding[0].userSelected |
| explanationOfBenefit.provider.identifier.system |
| explanationOfBenefit.provider.identifier.value |
| explanationOfBenefit.provider.type |
| explanationOfBenefit.payee.type.coding[0].system |
| explanationOfBenefit.payee.type.coding[0].code |
| explanationOfBenefit.payee.party.display |
| explanationOfBenefit.payee.party.reference |
| explanationOfBenefit.payee.party.identifier.use |
| explanationOfBenefit.payee.party.identifier.type.coding[0].system |
| explanationOfBenefit.payee.party.identifier.type.coding[0].code |
| explanationOfBenefit.payee.party.identifier.type.coding[0].userSelected |
| explanationOfBenefit.payee.party.identifier.system |
| explanationOfBenefit.payee.party.identifier.value |
| explanationOfBenefit.payee.party.type |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.code.coding[0].system |
| explanationOfBenefit.supportingInfo.code.coding[0].code |
| explanationOfBenefit.supportingInfo.code.coding[0].display |
| explanationOfBenefit.supportingInfo.code.text |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.timingDate |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.code.coding[0].system |
| explanationOfBenefit.supportingInfo.code.coding[0].code |
| explanationOfBenefit.supportingInfo.code.text |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.code.coding[0].system |
| explanationOfBenefit.supportingInfo.code.coding[0].code |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.code.coding[0].system |
| explanationOfBenefit.supportingInfo.code.coding[0].code |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.code.coding[0].system |
| explanationOfBenefit.supportingInfo.code.coding[0].code |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.timingPeriod.start |
| explanationOfBenefit.supportingInfo.timingPeriod.end |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.code.coding[0].system |
| explanationOfBenefit.supportingInfo.code.coding[0].code |
| explanationOfBenefit.supportingInfo.code.coding[0].display |
| explanationOfBenefit.supportingInfo.code.text |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit..supportingInfo.valueReference.identifier.use |
| explanationOfBenefit..supportingInfo.valueReference.identifier.type.coding[0].system |
| explanationOfBenefit..supportingInfo.valueReference.identifier.type.coding[0].code |
| explanationOfBenefit..supportingInfo.valueReference.identifier.type.coding[0].userSelected |
| explanationOfBenefit..supportingInfo.valueReference.identifier.system |
| explanationOfBenefit..supportingInfo.valueReference.identifier.value |
| explanationOfBenefit.. supportingInfo.valueReference.type |
| explanationOfBenefit..supportingInfo.valueReference.display |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.valueString |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.valueString |
| explanationOfBenefit..total.category.coding[0].system |
| explanationOfBenefit..total.category.coding[0].code |
| explanationOfBenefit..total.amount |
| explanationOfBenefit..total.category.coding[0].system |
| explanationOfBenefit..total.category.coding[0].code |
| explanationOfBenefit..total.amount.value |
| explanationOfBenefit..total.amount.currency |
| explanationOfBenefit..payment.type.coding[0].system |
| explanationOfBenefit..payment.type.coding[0].code |
| explanationOfBenefit..payment.date |
| explanationOfBenefit..created |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.valueQuantity.value |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.code.coding[0].code |
| explanationOfBenefit.supportingInfo.code.text |
| explanationOfBenefit.supportingInfo.code.coding[0].system |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.valueQuantity.value |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.code.coding[0].system |
| explanationOfBenefit.supportingInfo.code.coding[0].code |
| explanationOfBenefit.supportingInfo.sequence |
| explanationOfBenefit.supportingInfo.category.coding[0].system |
| explanationOfBenefit.supportingInfo.category.coding[0].code |
| explanationOfBenefit.supportingInfo.category.coding[0].display |
| explanationOfBenefit.supportingInfo.category.text |
| explanationOfBenefit.supportingInfo.code.coding[0].system |
| explanationOfBenefit.supportingInfo.code.coding[0].code |
| explanationOfBenefit..item.adjudication.category.coding[0].system |
| explanationOfBenefit..item.adjudication.category.coding[0].code |
| explanationOfBenefit..item.adjudication.category.coding[0].system |
| explanationOfBenefit..item.adjudication.category.coding[0].code |
| explanationOfBenefit..item.adjudication.amount.value |
| explanationOfBenefit..item.adjudication.amount.currency |
| explanationOfBenefit.Item.sequence |
| explanationOfBenefit..processNote.text |
| explanationOfBenefit..processNote.number, item.noteNumber |
| explanationOfBenefit.Item.servicedDate |
| explanationOfBenefit.Item.servicedPeriod.start |
| explanationOfBenefit.Item.servicedPeriod.end |
| explanationOfBenefit.item.locationCodeableConcept.coding[0].system |
| explanationOfBenefit.Item.locationCodeableConcept.coding[0].code |
| explanationOfBenefit.Item.locationCodeableConcept.text |
| explanationOfBenefit.item.revenue.coding[0].system |
| explanationOfBenefit.item.revenue.coding[0].code |
| explanationOfBenefit.Item.quantity.value |
| explanationOfBenefit.item.productOrService.coding[0].system |
| explanationOfBenefit.item.productOrService.coding[0].code |
| explanationOfBenefit.item.modifier[0].coding[0].system |
| explanationOfBenefit.item.modifier[0].coding[0].code |
| explanationOfBenefit.item.productOrService.coding[0].system |
| explanationOfBenefit.item.productOrService.coding[0].code |
| explanationOfBenefit.Item.quantity.value |
| explanationOfBenefit.Item.quantity.unit |
| explanationOfBenefit.Item.detail[0].sequence |
| explanationOfBenefit.item.detail[0].productOrService.coding[0].system |
| explanationOfBenefit.Item.detail[0].quantity.value |
| explanationOfBenefit.Item.detail[0].quantity.unit |
| explanationOfBenefit.Item.adjudication.category.coding[0].system |
| explanationOfBenefit.Item.adjudication.category.coding[0].code |
| explanationOfBenefit.Item.adjudication.reason.coding[0].system |
| explanationOfBenefit.Item.adjudication.reason.coding[0].code |
| explanationOfBenefit.Item.adjudication.category.coding[0].system |
| explanationOfBenefit.Item.adjudication.category.coding[0].code |
| explanationOfBenefit.Item.adjudication.reason.coding[0].system |
| explanationOfBenefit.Item.adjudication.reason.coding[0].code |
| explanationOfBenefit.Item.adjudication.category.coding[0].system |
| explanationOfBenefit.Item.adjudication.category.coding[0].code |
| explanationOfBenefit.Item.adjudication.reason.coding[0].system |
| explanationOfBenefit.Item.adjudication.reason.coding[0].code |
| explanationOfBenefit.Item.adjudication.category.coding[0].system |
| explanationOfBenefit.Item.adjudication.category.coding[0].code |
| explanationOfBenefit.Item.adjudication.value |
| explanationOfBenefit.careTeam.sequence , item.careTeamSequence |
| explanationOfBenefit.careTeam.role.coding[0].system |
| explanationOfBenefit.careTeam.role.coding[0].code |
| explanationOfBenefit.careTeam.provider.identifer.use |
| explanationOfBenefit.careTeam.provider.identifier.system |
| explanationOfBenefit.careTeam.provider.identifier.value |
| explanationOfBenefit.careTeam.provider.identifier.type.coding[0].system |
| explanationOfBenefit.careTeam.provider.identifier.type.coding[0].code |
| explanationOfBenefit.careTeam.provider.display |
| explanationOfBenefit.careTeam.provider.type |
| explanationOfBenefit.careTeam.qualification.coding[0].system |
| explanationOfBenefit.careTeam.qualification.coding[0].code |
| explanationOfBenefit.procedure.sequence |
| explanationOfBenefit.procedure.type[0].coding[0].system |
| explanationOfBenefit.procedure.type[0].coding[0].code |
| explanationOfBenefit.procedure.procedureCodeableConcept.coding[0].system |
| explanationOfBenefit.procedure.procedureCodeableConcept.coding[0].code |
| explanationOfBenefit.procedure.date |
| explanationOfBenefit.procedure.sequence |
| explanationOfBenefit.procedure.type[0].coding[0].system |
| explanationOfBenefit.procedure.type[0].coding[0].code |
| explanationOfBenefit.procedure.procedureCodeableConcept.coding[0].system |
| explanationOfBenefit.procedure.procedureCodeableConcept.coding[0].code |
| explanationOfBenefit.procedure.date |
| explanationOfBenefit.Diagnosis.sequence |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].system |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].code |
| explanationOfBenefit.diagnosis.type[0].coding[0].system |
| explanationOfBenefit.diagnosis.type[0].coding[0].code |
| explanationOfBenefit.diagnosis.sequence |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].system |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].code |
| explanationOfBenefit.diagnosis.type[0].coding[0].system |
| explanationOfBenefit.diagnosis.type[0].coding[0].code |
| explanationOfBenefit.diagnosis.sequence |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].system |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].code |
| explanationOfBenefit.diagnosis.type[0].coding[0].system |
| explanationOfBenefit.diagnosis.type[0].coding[0].code |
| explanationOfBenefit.diagnosis_item.onAdmission.coding[0].system |
| explanationOfBenefit.diagnosis_item.onAdmission.coding[0].code |
| explanationOfBenefit.diagnosis.sequence |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].system |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].code |
| explanationOfBenefit.diagnosis.type[0].coding[0].system |
| explanationOfBenefit.diagnosis.type[0].coding[0].code |
| explanationOfBenefit.diagnosis_item.onAdmission.coding[0].system |
| explanationOfBenefit.diagnosis_item.onAdmission.coding[0].code |
| explanationOfBenefit.diagnosis.sequence |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].system |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].code |
| explanationOfBenefit.diagnosis.type[0].coding[0].system |
| explanationOfBenefit.diagnosis.type[0].coding[0].code |
| explanationOfBenefit.diagnosis_item.onAdmission.coding[0].system |
| explanationOfBenefit.diagnosis_item.onAdmission.coding[0].code |
| explanationOfBenefit.diagnosis.sequence |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].system |
| explanationOfBenefit.diagnosis.diagnosisCodeableConcept.coding[0].code |
| explanationOfBenefit.diagnosis.type[0].coding[0].system |
| explanationOfBenefit.diagnosis.type[0].coding[0].code |
| explanationOfBenefit.diagnosis_item.onAdmission.coding[0].system |
| explanationOfBenefit.diagnosis_item.onAdmission.coding[0].code |
Codesets Mapping
| FHIR Data Element | Value Set | Binding Strength |
| identifier.use | IdentifierUse | required |
| identifier.type | C4BBClaimIdentifierType | extensible |
| status | ExplanationOfBenefitStatus | required |
| type | ClaimTypeCodes | required |
| subType | C4BBInstitutionalClaimSubType (inpatient & outpatient) | required |
| use | ClaimUse | required |
| related.relationship | C4BBRelatedClaimRelationshipCodes | required |
| payee.type | C4BBPayeeType | required |
| outcome | ClaimProcessingCodes | required |
careTeam.role |
C4BBClaimInstitutionalCareTeamRole (inpatient & outpatient) | required |
| C4BBClaimPharmacyTeamRole (pharmacy) | ||
| C4BBClaimProfessionalAndNonClinicianCareTeamRole (professional) | ||
| careTeam.qualification | HealthcareProviderTaxonomy | required |
| supportingInfo.category | C4BBSupportingInfoType | extensible |
| supportingInfo:billingnetworkcontractingstatus | C4BBPayerProviderContractingStatus | required |
| supportingInfo:typeofbill | AHANUBCTypeOfBill | required |
| supportingInfo:pointoforigin | AHANUBCPointOfOriginForAdmissionOrVisit | required |
| supportingInfo:admtype | AHANUBCPriorityTypeOfAdmissionOrVisit | required |
| supportingInfo:discharge-status | AHANUBCPatientDischargeStatus | required |
| supportingInfo:performingnetworkcontactingstatus | C4BBPayerProviderContractingStatus | required |
| supportingInfo:brandgenericindicator | NCPDPBrandGenericIndicator | required |
| supportingInfo:dawcode | NCPDPDispensedAsWrittenOrProductSelectionCode | required |
| supportingInfo:rxoriginCode | NCPDPPrescriptionOriginCode | required |
| payment.type.coding.code | C4BBPayerClaimPaymentStatusCode | required |
| item.revenue | AHANUBCRevenueCodes | required |
| item.productorservice | C4BBEOBInstitutionalProcedureCodes (inpatient & outpatient) | required |
| AMACPTCMSHCPCSProcedureCodes (professional) | ||
| FDANDCOrCompound (pharmacy) | ||
| item.detail.productorservice | FDANationalDrugCode | required |
| item.modifier | AMACPTCMSHCPCSModifiers | required |
| item.locationCodeableConcept | CMSPlaceofServiceCodes | required |
| total.category | C4BBTotalCategoryDiscriminator | extensible |
| total:benefitpaymentstatus | C4BBPayerBenefitPaymentStatus | required |
| item.adjudication:benefitpaymentstatus.category | C4BBPayerBenefitPaymentStatus | required |
| item.adjudication.category | C4BBAdjudicationCategoryDiscriminator | required |
| item.adjudication:denialreason.reason | X12ClaimAdjustmentReasonCodesCMSRemittanceAdviceRemarkCodes (inpatient, outpatient & professional) | required |
| NCPDPRejectCode (pharmacy) | required | |
| diagnosis.diagnosis[x] | CDCICD910CMDiagnosisCodes | required |
| diagnosis.onAdmission | AHANUBCPresentOnAdmission | required |
| diagnosis.type |
ExampleDiagnosisTypeCodes (pharmacy) | example |
| C4BBClaimProfessionalAndNonClinicianDiagnosisType (professional) | required |
|
| C4BBClaimInpatientInstitutionalDiagnosisType (inpatient) | ||
| C4BBClaimOutpatientInstitutionalDiagnosisType (outpatient) | ||
| procedure.type | C4BBClaimProcedureTypes (inpatient) | required |
| ExampleProcedureTypeCodes (other claims) | example | |
| procedure.procedure[x] | CMSICD910PCSProcedureCodes | required |