Blue Button 2.0 Implementation Guide

SD.2 StructureDefinition-bluebutton-carrier-claim

This profile sets minimum expectations for the [ExplanationOfBenefit] Carrier Claim resource to record, search and fetch basic demographics and other administrative information about an individual Carrier Claim. It identifies which core elements, extensions, vocabularies and value sets SHALL be present in the resource when using this profile.

Example Usage Scenarios:

The following are example usage scenarios for the Blue Button Carrier Claim profile:

Mandatory Data Elements and Terminology

The following data-elements are mandatory (i.e data MUST be present). These are presented below in a simple human-readable explanation. Profile specific guidance and examples are provided as well. The Formal Profile Definition below provides the formal summary, definitions, and terminology requirements.

Each Carrier claim must have:

  1. an id
  2. EOB identifiers
  3. a status
  4. a type
  5. a patient
  6. a billable period
  7. an insurance
  8. an item
  9. a payment
  10. the following EOB level extensions: - carrier-prpayamt-extension - carrier-carr-num-extension - carrier-asgmntcd-extension - carrier-carr-clm-cash-ddctbl-apld-amt-extension - carrier-carr-clm-pmt-dnl-cd-extension - carrier-nch-carr-clm-alowd-amt-extension - carrier-nch-carr-clm-sbmtd-chrg-amt-extension - carrier-nch-clm-bene-pmt-amt-extension - carrier-nch-clm-prvdr-pmt-amt-extension - carrier-clm-clncl-tril-num-extension

If the data is available a Carrier claim shall include:

  1. a referral
  2. a care team
  3. a diagnosis

Profile specific implementation guidance:

  • none

Examples

  • none

SD.2.1 Formal Views of Profile Content

Description of Profiles, Differentials, and Snapshots.

The official URL for this profile is: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-claim

Published on Wed Mar 21 16:11:24 UTC 2018 as a draft by .

This profile builds on ExplanationOfBenefit


Complete Summary of the Mandatory Requirements

  1. An id in ExplanationOfBenefit.id

  2. One or more … in ExplanationOfBenefit.identifier
    • each ExplanationOfBenefit.identifier must have:
      • an identifier.system
      • an identifier.value that is unique within the system.
  3. One status in ExplanationOfBenefit.status

  4. One type in ExplanationOfBenefit.type
    • an ExplanationOfBenefit.type must have:
      • a type.coding, and each coding must have: - a coding.system - a coding.code
  5. One patient in ExplanationOfBenefit.patient
    • an ExplanationOfBenefit.patient must have:
      • a patient.reference
  6. One type in ExplanationOfBenefit.billablePeriod
    • an ExplanationOfBenefit.billablePeriod must have:
      • a billablePeriod.start
      • a billablePeriod.end
  7. One insurance in ExplanationOfBenefit.insurance
    • an ExplanationOfBenefit.insurance must have:
      • an insurance.coverage, and a coverage must have: - a coverage.reference
  8. One or more item in ExplanationOfBenefit.item
    • an ExplanationOfBenefit.item must have:
      • an item.sequence
      • an item.category, and each category must have:
        • a category.coding, and each coding must have: - a coding.system - a coding.code
      • an item.service, and each service must have:
        • a service.coding, and each coding must have: - a coding.system - a coding.code
        • a service.carrier-carr-line-ansthsa-unit-cnt-extension
      • an item.modifier, and each modifier must have:
        • a modifier.coding, and each coding must have: - a coding.system - a coding.code
      • an item.serviced
      • an item.locationCodeableConcept, and each locationCodeableConcept must have: - a locationCodeableConcept.coding, and each coding must have: - a coding.system - a coding.code - a locationCodeableConcept.carrier-prvdr-state-cd-extension - a locationCodeableConcept.carrier-prvdr-zip-extension - a locationCodeableConcept.carrier-carr-line-prcng-lclty-cd-extension - a locationCodeableConcept.carrier-carr-line-clia-lab-num-extension
      • an item.quantity, and each quantity must have: - a quantity.value
      • one or more item.adjudication, and each adjudication must have: - an adjudication.category, and each category must have: - a category.coding, and each coding must have: - a coding.system - a coding.code
        • an adjudication.reason, and each reason must have: - a reason.coding, and each coding must have: - a coding.system - a coding.code
        • an adjudication.amount, and each amount must have: - a amount.value - a amount.system - a amount.code - an adjudication.carrier-line-pmt-80-100-cd-extension
      • an item.carrier-carr-line-mtus-cd-extension
      • an item.carrier-carr-line-mtus-cnt-extension
      • an item.carrier-betos-cd-extension
      • an item.carrier-line-bene-prmry-pyr-cd-extension
      • an item.carrier-line-service-deductible-extension
      • an item.carrier-line-hct-hgb-rslt-num-extension
      • an item.carrier-ndc-extension
  9. A payment in ExplanationOfBenefit.payment
    • an ExplanationOfBenefit.payment must have:
      • a payment.amount, and each amount must have:
        • a amount.value
        • a amount.system
  10. The following ExplanationOfBenefit extensions: - ExplanationOfBenefit.carrier-prpayamt-extension - ExplanationOfBenefit.carrier-carr-num-extension - ExplanationOfBenefit.carrier-asgmntcd-extension - ExplanationOfBenefit.carrier-carr-clm-cash-ddctbl-apld-amt-extension - ExplanationOfBenefit.carrier-carr-clm-pmt-dnl-cd-extension - ExplanationOfBenefit.carrier-nch-carr-clm-alowd-amt-extension - ExplanationOfBenefit.carrier-nch-carr-clm-sbmtd-chrg-amt-extension - ExplanationOfBenefit.carrier-nch-clm-bene-pmt-amt-extension - ExplanationOfBenefit.carrier-nch-clm-prvdr-pmt-amt-extension - ExplanationOfBenefit.carrier-clm-clncl-tril-num-extension

Summary of the Must Support Requirements

Additionally your system must support:

  1. One referral in ExplanationOfBenefit.referral
    • an ExplanationOfBenefit.referral must have:
      • a referral.reference
  2. One or more care team in ExplanationOfBenefit.careTeam
    • an ExplanationOfBenefit.careTeam must have:
      • a careTeam.sequence
      • a careTeam.provider, and each provider must have: - a provider.identifer
      • a careTeam.role, and each role must have: - a role.coding, and each coding must have: - a coding.system - a coding.code
      • a careTeam.qualification, and each qualification must have: - a qualification.coding, and each coding must have: - a coding.system - a coding.code
      • a careTeam.carrier-line-prvdr-type-cd-extension
      • a careTeam.carrier-prtcptng-ind-cd-extension
      • a careTeam.carrier-us-npi-extension
  3. One or more diagnosis in ExplanationOfBenefit.diagnosis
    • an ExplanationOfBenefit.diagnosis must have:
      • a diagnosis.sequence
      • a diagnosis.diagnosis
      • a diagnosis.type, and each type must have: - a type.coding, and each coding must have: - a coding.system - a coding.code
NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit 0..*Explanation of Benefit resource
... id 1..
... meta ..0
... implicitRules ..0
... language ..0
... text ..0
... identifier 1..
.... id ..0
.... use ..0
.... type ..0
.... system 1..
.... value 1..
.... period ..0
.... assigner ..0
... status 1..
... type 1..
.... id ..0
.... coding 1..
..... id ..0
..... system 1..
..... version ..0
..... code 1..
..... display 1..
..... userSelected ..0
... subType ..0
... patient 1..
.... id ..0
.... reference 1..
.... identifier ..0
.... display ..0
... billablePeriod 1..
.... id ..0
.... start 1..
.... end 1..
... created ..0
... enterer ..0
... insurer ..0
... provider ..0
... organization ..0
... facility ..0
... claim ..0
... claimResponse ..0
... outcome ..0
... disposition ..0
... related ..0
... prescription ..0
... originalPrescription ..0
... payee ..0
... information ..0
... procedure ..0
... precedence ..0
... insurance 1..
.... id ..0
.... coverage 1..
..... id ..0
..... reference 1..
..... identifier ..0
..... display ..0
.... preAuthRef ..0
... accident ..0
... employmentImpacted ..0
... hospitalization ..0
... item 1..
.... id ..0
.... careTeamLinkId ..0
.... procedureLinkId ..0
.... informationLinkId ..0
.... revenue ..0
.... modifier ..1
..... id ..0
..... coding 1..1
...... id ..0
...... system 1..
...... version 1..
...... code 1..
...... display ..0
...... userSelected ..0
..... text ..0
.... programCode ..0
.... locationCodeableConcept CodeableConcept
..... id ..0
..... text ..0
..... bluebutton-carrier-prvdr-state-cd-extension 1..1CodingNCH Provider SSA State Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prvdr-state-cd-extension
..... bluebutton-carrier-prvdr-zip-extension 1..1CodingCarrier Line Performing Provider ZIP Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prvdr-zip-extension
..... bluebutton-carrier-carr-line-prcng-lclty-cd-extension 1..1CodingCarrier Line Pricing Locality Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-prcng-lclty-cd-extension
..... bluebutton-carrier-carr-line-clia-lab-num-extension 1..1IdentifierClinical Laboratory Improvement Amendments (CLIA) monitored laboratory number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-clia-lab-num-extension
.... unitPrice ..0
.... factor ..0
.... net ..0
.... udi ..0
.... bodySite ..0
.... subSite ..0
.... encounter ..0
.... noteNumber ..0
.... detail ..0
.... bluebutton-carrier-carr-line-mtus-cd-extension 1..1CodingCarrier Line Miles/Time/Units/Services (MTUS) Indicator Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-mtus-cd-extension
.... bluebutton-carrier-carr-line-mtus-cnt-extension 1..1QuantityCarrier Line Miles/Time/Units/Services (MTUS) Count
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-mtus-cnt-extension
.... bluebutton-carrier-betos-cd-extension 1..1CodingLine Berenson-Eggers Type of Service (BETOS) Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-betos-cd-extension
.... bluebutton-carrier-line-bene-prmry-pyr-cd-extension 1..1CodingLine Beneficiary Primary Payer Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-bene-prmry-pyr-cd-extension
.... bluebutton-carrier-line-service-deductible-extension 1..1CodingLine Service Deductible Indicator Switch
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-service-deductible-extension
.... bluebutton-carrier-line-hct-hgb-rslt-num-extension 1..1Reference()Hematocrit / Hemoglobin Test Results
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-hct-hgb-rslt-num-extension
.... bluebutton-carrier-ndc-extension 1..1CodingLine National Drug Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-ndc-extension
... addItem ..0
... totalCost ..0
... unallocDeductable ..0
... totalBenefit ..0
... payment 1..
.... id ..0
.... type ..0
.... adjustment ..0
.... adjustmentReason ..0
.... date ..0
.... amount 1..
..... id ..0
..... value 1..
..... comparator ..0
..... unit ..0
..... system 1..
..... code ..0
.... identifier ..0
... form ..0
... processNote ..0
... benefitBalance ..0
... bluebutton-carrier-prpayamt-extension 1..1MoneyNCH Primary Payer (if not Medicare) Claim Paid Amount
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prpayamt-extension
... bluebutton-carrier-carr-num-extension 1..1IdentifierCarrier or MAC Number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-num-extension
... bluebutton-carrier-asgmntcd-extension 1..1CodingCarrier Claim Provider Assignment Indicator Switch
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-asgmntcd-extension
... bluebutton-carrier-carr-clm-cash-ddctbl-apld-amt-extension 1..1MoneyCarrier Claim Cash Deductible Applied Amount (sum of all line-level deductible amounts)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-cash-ddctbl-apld-amt-extension
... bluebutton-carrier-carr-clm-pmt-dnl-cd-extension 1..1CodingCarrier Claim Payment Denial Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-pmt-dnl-cd-extension
... bluebutton-carrier-nch-carr-clm-alowd-amt-extension 1..1MoneyNCH Carrier Claim Allowed Charge Amount (sum of all line-level allowed charges)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-carr-clm-alowd-amt-extension
... bluebutton-carrier-nch-carr-clm-sbmtd-chrg-amt-extension 1..1MoneyNCH Carrier Claim Submitted Charge Amount (sum of all line-level submitted charges)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-carr-clm-sbmtd-chrg-amt-extension
... bluebutton-carrier-nch-clm-bene-pmt-amt-extension 1..1MoneyNCH Claim Payment Amount to Beneficiary
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-clm-bene-pmt-amt-extension
... bluebutton-carrier-nch-clm-prvdr-pmt-amt-extension 1..1MoneyNCH Claim Provider Payment Amount
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-clm-prvdr-pmt-amt-extension
... bluebutton-carrier-clm-clncl-tril-num-extension 1..1IdentifierClinical Trial Number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-clm-clncl-tril-num-extension

doco Documentation for this format
NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit 0..*Explanation of Benefit resource
... id Σ1..1idLogical id of this artifact
... bluebutton-carrier-prpayamt-extension 1..1MoneyNCH Primary Payer (if not Medicare) Claim Paid Amount
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prpayamt-extension
... bluebutton-carrier-carr-num-extension 1..1IdentifierCarrier or MAC Number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-num-extension
Binding: Carrier or MAC Number (required)
... bluebutton-carrier-asgmntcd-extension 1..1CodingCarrier Claim Provider Assignment Indicator Switch
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-asgmntcd-extension
Binding: Carrier Claim Provider Assignment Indicator Switch (required)
... bluebutton-carrier-carr-clm-cash-ddctbl-apld-amt-extension 1..1MoneyCarrier Claim Cash Deductible Applied Amount (sum of all line-level deductible amounts)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-cash-ddctbl-apld-amt-extension
... bluebutton-carrier-carr-clm-pmt-dnl-cd-extension 1..1CodingCarrier Claim Payment Denial Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-pmt-dnl-cd-extension
Binding: Carrier Claim Payment Denial Code (required)
... bluebutton-carrier-nch-carr-clm-alowd-amt-extension 1..1MoneyNCH Carrier Claim Allowed Charge Amount (sum of all line-level allowed charges)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-carr-clm-alowd-amt-extension
... bluebutton-carrier-nch-carr-clm-sbmtd-chrg-amt-extension 1..1MoneyNCH Carrier Claim Submitted Charge Amount (sum of all line-level submitted charges)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-carr-clm-sbmtd-chrg-amt-extension
... bluebutton-carrier-nch-clm-bene-pmt-amt-extension 1..1MoneyNCH Claim Payment Amount to Beneficiary
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-clm-bene-pmt-amt-extension
... bluebutton-carrier-nch-clm-prvdr-pmt-amt-extension 1..1MoneyNCH Claim Provider Payment Amount
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-clm-prvdr-pmt-amt-extension
... bluebutton-carrier-clm-clncl-tril-num-extension 1..1IdentifierClinical Trial Number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-clm-clncl-tril-num-extension
... identifier 1..*IdentifierBusiness Identifier
.... system Σ1..1uriThe namespace for the identifier value
Example General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
.... value Σ1..1stringThe value that is unique
Example General': 123456
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: ExplanationOfBenefitStatus (required)
... type 1..1CodeableConceptType or discipline
Binding: Example Claim Type Codes (required)
.... coding Σ1..*CodingCode defined by a terminology system
..... system Σ1..1uriIdentity of the terminology system
..... code Σ1..1codeSymbol in syntax defined by the system
..... display Σ1..1stringRepresentation defined by the system
.... text Σ0..1stringPlain text representation of the concept
... patient 1..1Reference(Patient)The subject of the Products and Services
.... reference Σ1..1stringLiteral reference, Relative, internal or absolute URL
... billablePeriod 1..1PeriodPeriod for charge submission
.... start ΣI1..1dateTimeStarting time with inclusive boundary
.... end ΣI1..1dateTimeEnd time with inclusive boundary, if not ongoing
... referral 0..1Reference(ReferralRequest)Treatment Referral
.... reference Σ1..1stringLiteral reference, Relative, internal or absolute URL
... careTeam 0..*BackboneElementCare Team members
.... bluebutton-carrier-carr-line-prvdr-type-cd-extension 1..1CodingCarrier Line Provider Type Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-prvdr-type-cd-extension
Binding: Carrier Line Provider Type Code (required)
.... bluebutton-carrier-prtcptng-ind-cd-extension 1..1CodingLine Provider Participating Indicator Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prtcptng-ind-cd-extension
Binding: Line Provider Participating Indicator Code (required)
.... bluebutton-carrier-us-npi-extension 1..1CodingOrganization (or group) NPI Number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-us-npi-extension
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntNumber to covey order of careteam
.... provider 1..1Reference(Practitioner), Reference(Organization)Member of the Care Team
..... identifier Σ1..1IdentifierLogical reference, when literal reference is not known
.... role 1..1CodeableConceptRole on the team
Binding: Claim Care Team Role Codes (example)
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
.... qualification 1..1CodeableConceptType, classification or Specialization
Binding: Example Provider Qualification Codes (example)
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
... diagnosis 0..*BackboneElementList of Diagnosis
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntNumber to covey order of diagnosis
.... diagnosis[x] 1..1CodeableConcept, Reference(Condition)Patient's diagnosis
Binding: ICD-10 Codes (example)
.... type 0..1CodeableConceptTiming or nature of the diagnosis
Binding: Example Diagnosis Type Codes (example)
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ0..1uriIdentity of the terminology system
...... code Σ0..1codeSymbol in syntax defined by the system
... insurance 1..1BackboneElementInsurance or medical plan
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... coverage 1..1Reference(Coverage)Insurance information
..... reference Σ1..1stringLiteral reference, Relative, internal or absolute URL
... item 1..*BackboneElementGoods and Services
.... bluebutton-carrier-carr-line-mtus-cd-extension 1..1CodingCarrier Line Miles/Time/Units/Services (MTUS) Indicator Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-mtus-cd-extension
Binding: Carrier Line Miles/Time/Units/Services (MTUS) Indicator Code (required)
.... bluebutton-carrier-carr-line-mtus-cnt-extension 1..1QuantityCarrier Line Miles/Time/Units/Services (MTUS) Count
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-mtus-cnt-extension
.... bluebutton-carrier-betos-cd-extension 1..1CodingLine Berenson-Eggers Type of Service (BETOS) Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-betos-cd-extension
Binding: Line Berenson-Eggers Type of Service (BETOS) Code (required)
.... bluebutton-carrier-line-bene-prmry-pyr-cd-extension 1..1CodingLine Beneficiary Primary Payer Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-bene-prmry-pyr-cd-extension
Binding: Line Primary Payer Code (if not Medicare) (required)
.... bluebutton-carrier-line-service-deductible-extension 1..1CodingLine Service Deductible Indicator Switch
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-service-deductible-extension
Binding: Line Service Deductible Indicator Switch (required)
.... bluebutton-carrier-line-hct-hgb-rslt-num-extension 1..1Reference()Hematocrit / Hemoglobin Test Results
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-hct-hgb-rslt-num-extension
.... bluebutton-carrier-ndc-extension 1..1CodingLine National Drug Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-ndc-extension
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntService instance
.... diagnosisLinkId 0..*positiveIntApplicable diagnoses
.... category 0..1CodeableConceptType of service or product
Binding: Benefit SubCategory Codes (example)
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
.... service 0..1CodeableConceptBilling Code
Binding: USCLS Codes (example)
..... bluebutton-carrier-carr-line-ansthsa-unit-cnt-extension 1..1QuantityCarrier Line Anesthesia Unit Count
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-ansthsa-unit-cnt-extension
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... version Σ1..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
.... modifier 0..1CodeableConceptService/Product billing modifiers
Binding: Modifier type Codes (example)
..... coding Σ1..1CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... version Σ1..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
.... serviced[x] 0..1date, PeriodDate or dates of Service
.... locationCodeableConcept 0..1CodeableConceptPlace of service
Binding: Example Service Place Codes (example)
..... bluebutton-carrier-prvdr-state-cd-extension 1..1CodingNCH Provider SSA State Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prvdr-state-cd-extension
Binding: NCH Provider SSA State Code (required)
..... bluebutton-carrier-prvdr-zip-extension 1..1CodingCarrier Line Performing Provider ZIP Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prvdr-zip-extension
..... bluebutton-carrier-carr-line-prcng-lclty-cd-extension 1..1CodingCarrier Line Pricing Locality Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-prcng-lclty-cd-extension
Binding: Carrier Line Pricing Locality Code (required)
..... bluebutton-carrier-carr-line-clia-lab-num-extension 1..1IdentifierClinical Laboratory Improvement Amendments (CLIA) monitored laboratory number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-clia-lab-num-extension
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
.... quantity 0..1SimpleQuantityCount of Products or Services
..... value Σ0..1decimalNumerical value (with implicit precision)
.... adjudication 0..*BackboneElementAdjudication details
..... bluebutton-carrier-line-pmt-80-100-cd-extension 1..1CodingLine Payment 80% / 100% Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-pmt-80-100-cd-extension
Binding: Line Payment 80% / 100% Code (required)
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... category 1..1CodeableConceptAdjudication category such as co-pay, eligible, benefit, etc.
Binding: Adjudication Value Codes (example)
...... coding Σ0..*CodingCode defined by a terminology system
....... system Σ1..1uriIdentity of the terminology system
....... code Σ1..1codeSymbol in syntax defined by the system
....... display Σ1..1stringRepresentation defined by the system
..... reason 0..1CodeableConceptExplanation of Adjudication outcome
Binding: Adjudication Reason Codes (example)
...... coding Σ0..*CodingCode defined by a terminology system
....... system Σ1..1uriIdentity of the terminology system
....... code Σ1..1codeSymbol in syntax defined by the system
....... display Σ1..1stringRepresentation defined by the system
..... amount 0..1MoneyMonetary amount
...... value Σ1..1decimalNumerical value (with implicit precision)
...... system ΣI1..1uriSystem that defines coded unit form
...... code Σ1..1codeCoded form of the unit
... payment 1..1BackboneElementPayment (if paid)
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... amount 1..1MoneyPayable amount after adjustment
..... value Σ1..1decimalNumerical value (with implicit precision)
..... system ΣI1..1uriSystem that defines coded unit form

doco Documentation for this format

Complete Summary of the Mandatory Requirements

  1. An id in ExplanationOfBenefit.id

  2. One or more … in ExplanationOfBenefit.identifier
    • each ExplanationOfBenefit.identifier must have:
      • an identifier.system
      • an identifier.value that is unique within the system.
  3. One status in ExplanationOfBenefit.status

  4. One type in ExplanationOfBenefit.type
    • an ExplanationOfBenefit.type must have:
      • a type.coding, and each coding must have: - a coding.system - a coding.code
  5. One patient in ExplanationOfBenefit.patient
    • an ExplanationOfBenefit.patient must have:
      • a patient.reference
  6. One type in ExplanationOfBenefit.billablePeriod
    • an ExplanationOfBenefit.billablePeriod must have:
      • a billablePeriod.start
      • a billablePeriod.end
  7. One insurance in ExplanationOfBenefit.insurance
    • an ExplanationOfBenefit.insurance must have:
      • an insurance.coverage, and a coverage must have: - a coverage.reference
  8. One or more item in ExplanationOfBenefit.item
    • an ExplanationOfBenefit.item must have:
      • an item.sequence
      • an item.category, and each category must have:
        • a category.coding, and each coding must have: - a coding.system - a coding.code
      • an item.service, and each service must have:
        • a service.coding, and each coding must have: - a coding.system - a coding.code
        • a service.carrier-carr-line-ansthsa-unit-cnt-extension
      • an item.modifier, and each modifier must have:
        • a modifier.coding, and each coding must have: - a coding.system - a coding.code
      • an item.serviced
      • an item.locationCodeableConcept, and each locationCodeableConcept must have: - a locationCodeableConcept.coding, and each coding must have: - a coding.system - a coding.code - a locationCodeableConcept.carrier-prvdr-state-cd-extension - a locationCodeableConcept.carrier-prvdr-zip-extension - a locationCodeableConcept.carrier-carr-line-prcng-lclty-cd-extension - a locationCodeableConcept.carrier-carr-line-clia-lab-num-extension
      • an item.quantity, and each quantity must have: - a quantity.value
      • one or more item.adjudication, and each adjudication must have: - an adjudication.category, and each category must have: - a category.coding, and each coding must have: - a coding.system - a coding.code
        • an adjudication.reason, and each reason must have: - a reason.coding, and each coding must have: - a coding.system - a coding.code
        • an adjudication.amount, and each amount must have: - a amount.value - a amount.system - a amount.code - an adjudication.carrier-line-pmt-80-100-cd-extension
      • an item.carrier-carr-line-mtus-cd-extension
      • an item.carrier-carr-line-mtus-cnt-extension
      • an item.carrier-betos-cd-extension
      • an item.carrier-line-bene-prmry-pyr-cd-extension
      • an item.carrier-line-service-deductible-extension
      • an item.carrier-line-hct-hgb-rslt-num-extension
      • an item.carrier-ndc-extension
  9. A payment in ExplanationOfBenefit.payment
    • an ExplanationOfBenefit.payment must have:
      • a payment.amount, and each amount must have:
        • a amount.value
        • a amount.system
  10. The following ExplanationOfBenefit extensions: - ExplanationOfBenefit.carrier-prpayamt-extension - ExplanationOfBenefit.carrier-carr-num-extension - ExplanationOfBenefit.carrier-asgmntcd-extension - ExplanationOfBenefit.carrier-carr-clm-cash-ddctbl-apld-amt-extension - ExplanationOfBenefit.carrier-carr-clm-pmt-dnl-cd-extension - ExplanationOfBenefit.carrier-nch-carr-clm-alowd-amt-extension - ExplanationOfBenefit.carrier-nch-carr-clm-sbmtd-chrg-amt-extension - ExplanationOfBenefit.carrier-nch-clm-bene-pmt-amt-extension - ExplanationOfBenefit.carrier-nch-clm-prvdr-pmt-amt-extension - ExplanationOfBenefit.carrier-clm-clncl-tril-num-extension

Summary of the Must Support Requirements

Additionally your system must support:

  1. One referral in ExplanationOfBenefit.referral
    • an ExplanationOfBenefit.referral must have:
      • a referral.reference
  2. One or more care team in ExplanationOfBenefit.careTeam
    • an ExplanationOfBenefit.careTeam must have:
      • a careTeam.sequence
      • a careTeam.provider, and each provider must have: - a provider.identifer
      • a careTeam.role, and each role must have: - a role.coding, and each coding must have: - a coding.system - a coding.code
      • a careTeam.qualification, and each qualification must have: - a qualification.coding, and each coding must have: - a coding.system - a coding.code
      • a careTeam.carrier-line-prvdr-type-cd-extension
      • a careTeam.carrier-prtcptng-ind-cd-extension
      • a careTeam.carrier-us-npi-extension
  3. One or more diagnosis in ExplanationOfBenefit.diagnosis
    • an ExplanationOfBenefit.diagnosis must have:
      • a diagnosis.sequence
      • a diagnosis.diagnosis
      • a diagnosis.type, and each type must have: - a type.coding, and each coding must have: - a coding.system - a coding.code

Differential View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit 0..*Explanation of Benefit resource
... id 1..
... meta ..0
... implicitRules ..0
... language ..0
... text ..0
... identifier 1..
.... id ..0
.... use ..0
.... type ..0
.... system 1..
.... value 1..
.... period ..0
.... assigner ..0
... status 1..
... type 1..
.... id ..0
.... coding 1..
..... id ..0
..... system 1..
..... version ..0
..... code 1..
..... display 1..
..... userSelected ..0
... subType ..0
... patient 1..
.... id ..0
.... reference 1..
.... identifier ..0
.... display ..0
... billablePeriod 1..
.... id ..0
.... start 1..
.... end 1..
... created ..0
... enterer ..0
... insurer ..0
... provider ..0
... organization ..0
... facility ..0
... claim ..0
... claimResponse ..0
... outcome ..0
... disposition ..0
... related ..0
... prescription ..0
... originalPrescription ..0
... payee ..0
... information ..0
... procedure ..0
... precedence ..0
... insurance 1..
.... id ..0
.... coverage 1..
..... id ..0
..... reference 1..
..... identifier ..0
..... display ..0
.... preAuthRef ..0
... accident ..0
... employmentImpacted ..0
... hospitalization ..0
... item 1..
.... id ..0
.... careTeamLinkId ..0
.... procedureLinkId ..0
.... informationLinkId ..0
.... revenue ..0
.... modifier ..1
..... id ..0
..... coding 1..1
...... id ..0
...... system 1..
...... version 1..
...... code 1..
...... display ..0
...... userSelected ..0
..... text ..0
.... programCode ..0
.... locationCodeableConcept CodeableConcept
..... id ..0
..... text ..0
..... bluebutton-carrier-prvdr-state-cd-extension 1..1CodingNCH Provider SSA State Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prvdr-state-cd-extension
..... bluebutton-carrier-prvdr-zip-extension 1..1CodingCarrier Line Performing Provider ZIP Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prvdr-zip-extension
..... bluebutton-carrier-carr-line-prcng-lclty-cd-extension 1..1CodingCarrier Line Pricing Locality Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-prcng-lclty-cd-extension
..... bluebutton-carrier-carr-line-clia-lab-num-extension 1..1IdentifierClinical Laboratory Improvement Amendments (CLIA) monitored laboratory number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-clia-lab-num-extension
.... unitPrice ..0
.... factor ..0
.... net ..0
.... udi ..0
.... bodySite ..0
.... subSite ..0
.... encounter ..0
.... noteNumber ..0
.... detail ..0
.... bluebutton-carrier-carr-line-mtus-cd-extension 1..1CodingCarrier Line Miles/Time/Units/Services (MTUS) Indicator Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-mtus-cd-extension
.... bluebutton-carrier-carr-line-mtus-cnt-extension 1..1QuantityCarrier Line Miles/Time/Units/Services (MTUS) Count
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-mtus-cnt-extension
.... bluebutton-carrier-betos-cd-extension 1..1CodingLine Berenson-Eggers Type of Service (BETOS) Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-betos-cd-extension
.... bluebutton-carrier-line-bene-prmry-pyr-cd-extension 1..1CodingLine Beneficiary Primary Payer Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-bene-prmry-pyr-cd-extension
.... bluebutton-carrier-line-service-deductible-extension 1..1CodingLine Service Deductible Indicator Switch
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-service-deductible-extension
.... bluebutton-carrier-line-hct-hgb-rslt-num-extension 1..1Reference()Hematocrit / Hemoglobin Test Results
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-hct-hgb-rslt-num-extension
.... bluebutton-carrier-ndc-extension 1..1CodingLine National Drug Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-ndc-extension
... addItem ..0
... totalCost ..0
... unallocDeductable ..0
... totalBenefit ..0
... payment 1..
.... id ..0
.... type ..0
.... adjustment ..0
.... adjustmentReason ..0
.... date ..0
.... amount 1..
..... id ..0
..... value 1..
..... comparator ..0
..... unit ..0
..... system 1..
..... code ..0
.... identifier ..0
... form ..0
... processNote ..0
... benefitBalance ..0
... bluebutton-carrier-prpayamt-extension 1..1MoneyNCH Primary Payer (if not Medicare) Claim Paid Amount
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prpayamt-extension
... bluebutton-carrier-carr-num-extension 1..1IdentifierCarrier or MAC Number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-num-extension
... bluebutton-carrier-asgmntcd-extension 1..1CodingCarrier Claim Provider Assignment Indicator Switch
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-asgmntcd-extension
... bluebutton-carrier-carr-clm-cash-ddctbl-apld-amt-extension 1..1MoneyCarrier Claim Cash Deductible Applied Amount (sum of all line-level deductible amounts)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-cash-ddctbl-apld-amt-extension
... bluebutton-carrier-carr-clm-pmt-dnl-cd-extension 1..1CodingCarrier Claim Payment Denial Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-pmt-dnl-cd-extension
... bluebutton-carrier-nch-carr-clm-alowd-amt-extension 1..1MoneyNCH Carrier Claim Allowed Charge Amount (sum of all line-level allowed charges)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-carr-clm-alowd-amt-extension
... bluebutton-carrier-nch-carr-clm-sbmtd-chrg-amt-extension 1..1MoneyNCH Carrier Claim Submitted Charge Amount (sum of all line-level submitted charges)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-carr-clm-sbmtd-chrg-amt-extension
... bluebutton-carrier-nch-clm-bene-pmt-amt-extension 1..1MoneyNCH Claim Payment Amount to Beneficiary
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-clm-bene-pmt-amt-extension
... bluebutton-carrier-nch-clm-prvdr-pmt-amt-extension 1..1MoneyNCH Claim Provider Payment Amount
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-clm-prvdr-pmt-amt-extension
... bluebutton-carrier-clm-clncl-tril-num-extension 1..1IdentifierClinical Trial Number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-clm-clncl-tril-num-extension

doco Documentation for this format

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. ExplanationOfBenefit 0..*Explanation of Benefit resource
... id Σ1..1idLogical id of this artifact
... bluebutton-carrier-prpayamt-extension 1..1MoneyNCH Primary Payer (if not Medicare) Claim Paid Amount
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prpayamt-extension
... bluebutton-carrier-carr-num-extension 1..1IdentifierCarrier or MAC Number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-num-extension
Binding: Carrier or MAC Number (required)
... bluebutton-carrier-asgmntcd-extension 1..1CodingCarrier Claim Provider Assignment Indicator Switch
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-asgmntcd-extension
Binding: Carrier Claim Provider Assignment Indicator Switch (required)
... bluebutton-carrier-carr-clm-cash-ddctbl-apld-amt-extension 1..1MoneyCarrier Claim Cash Deductible Applied Amount (sum of all line-level deductible amounts)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-cash-ddctbl-apld-amt-extension
... bluebutton-carrier-carr-clm-pmt-dnl-cd-extension 1..1CodingCarrier Claim Payment Denial Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-pmt-dnl-cd-extension
Binding: Carrier Claim Payment Denial Code (required)
... bluebutton-carrier-nch-carr-clm-alowd-amt-extension 1..1MoneyNCH Carrier Claim Allowed Charge Amount (sum of all line-level allowed charges)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-carr-clm-alowd-amt-extension
... bluebutton-carrier-nch-carr-clm-sbmtd-chrg-amt-extension 1..1MoneyNCH Carrier Claim Submitted Charge Amount (sum of all line-level submitted charges)
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-carr-clm-sbmtd-chrg-amt-extension
... bluebutton-carrier-nch-clm-bene-pmt-amt-extension 1..1MoneyNCH Claim Payment Amount to Beneficiary
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-clm-bene-pmt-amt-extension
... bluebutton-carrier-nch-clm-prvdr-pmt-amt-extension 1..1MoneyNCH Claim Provider Payment Amount
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-nch-clm-prvdr-pmt-amt-extension
... bluebutton-carrier-clm-clncl-tril-num-extension 1..1IdentifierClinical Trial Number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-clm-clncl-tril-num-extension
... identifier 1..*IdentifierBusiness Identifier
.... system Σ1..1uriThe namespace for the identifier value
Example General': http://www.acme.com/identifiers/patient or urn:ietf:rfc:3986 if the Identifier.value itself is a full uri
.... value Σ1..1stringThe value that is unique
Example General': 123456
... status ?!Σ1..1codeactive | cancelled | draft | entered-in-error
Binding: ExplanationOfBenefitStatus (required)
... type 1..1CodeableConceptType or discipline
Binding: Example Claim Type Codes (required)
.... coding Σ1..*CodingCode defined by a terminology system
..... system Σ1..1uriIdentity of the terminology system
..... code Σ1..1codeSymbol in syntax defined by the system
..... display Σ1..1stringRepresentation defined by the system
.... text Σ0..1stringPlain text representation of the concept
... patient 1..1Reference(Patient)The subject of the Products and Services
.... reference Σ1..1stringLiteral reference, Relative, internal or absolute URL
... billablePeriod 1..1PeriodPeriod for charge submission
.... start ΣI1..1dateTimeStarting time with inclusive boundary
.... end ΣI1..1dateTimeEnd time with inclusive boundary, if not ongoing
... referral 0..1Reference(ReferralRequest)Treatment Referral
.... reference Σ1..1stringLiteral reference, Relative, internal or absolute URL
... careTeam 0..*BackboneElementCare Team members
.... bluebutton-carrier-carr-line-prvdr-type-cd-extension 1..1CodingCarrier Line Provider Type Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-prvdr-type-cd-extension
Binding: Carrier Line Provider Type Code (required)
.... bluebutton-carrier-prtcptng-ind-cd-extension 1..1CodingLine Provider Participating Indicator Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prtcptng-ind-cd-extension
Binding: Line Provider Participating Indicator Code (required)
.... bluebutton-carrier-us-npi-extension 1..1CodingOrganization (or group) NPI Number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-us-npi-extension
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntNumber to covey order of careteam
.... provider 1..1Reference(Practitioner), Reference(Organization)Member of the Care Team
..... identifier Σ1..1IdentifierLogical reference, when literal reference is not known
.... role 1..1CodeableConceptRole on the team
Binding: Claim Care Team Role Codes (example)
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
.... qualification 1..1CodeableConceptType, classification or Specialization
Binding: Example Provider Qualification Codes (example)
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
... diagnosis 0..*BackboneElementList of Diagnosis
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntNumber to covey order of diagnosis
.... diagnosis[x] 1..1CodeableConcept, Reference(Condition)Patient's diagnosis
Binding: ICD-10 Codes (example)
.... type 0..1CodeableConceptTiming or nature of the diagnosis
Binding: Example Diagnosis Type Codes (example)
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ0..1uriIdentity of the terminology system
...... code Σ0..1codeSymbol in syntax defined by the system
... insurance 1..1BackboneElementInsurance or medical plan
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... coverage 1..1Reference(Coverage)Insurance information
..... reference Σ1..1stringLiteral reference, Relative, internal or absolute URL
... item 1..*BackboneElementGoods and Services
.... bluebutton-carrier-carr-line-mtus-cd-extension 1..1CodingCarrier Line Miles/Time/Units/Services (MTUS) Indicator Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-mtus-cd-extension
Binding: Carrier Line Miles/Time/Units/Services (MTUS) Indicator Code (required)
.... bluebutton-carrier-carr-line-mtus-cnt-extension 1..1QuantityCarrier Line Miles/Time/Units/Services (MTUS) Count
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-mtus-cnt-extension
.... bluebutton-carrier-betos-cd-extension 1..1CodingLine Berenson-Eggers Type of Service (BETOS) Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-betos-cd-extension
Binding: Line Berenson-Eggers Type of Service (BETOS) Code (required)
.... bluebutton-carrier-line-bene-prmry-pyr-cd-extension 1..1CodingLine Beneficiary Primary Payer Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-bene-prmry-pyr-cd-extension
Binding: Line Primary Payer Code (if not Medicare) (required)
.... bluebutton-carrier-line-service-deductible-extension 1..1CodingLine Service Deductible Indicator Switch
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-service-deductible-extension
Binding: Line Service Deductible Indicator Switch (required)
.... bluebutton-carrier-line-hct-hgb-rslt-num-extension 1..1Reference()Hematocrit / Hemoglobin Test Results
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-hct-hgb-rslt-num-extension
.... bluebutton-carrier-ndc-extension 1..1CodingLine National Drug Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-ndc-extension
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... sequence 1..1positiveIntService instance
.... diagnosisLinkId 0..*positiveIntApplicable diagnoses
.... category 0..1CodeableConceptType of service or product
Binding: Benefit SubCategory Codes (example)
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
.... service 0..1CodeableConceptBilling Code
Binding: USCLS Codes (example)
..... bluebutton-carrier-carr-line-ansthsa-unit-cnt-extension 1..1QuantityCarrier Line Anesthesia Unit Count
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-ansthsa-unit-cnt-extension
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... version Σ1..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
.... modifier 0..1CodeableConceptService/Product billing modifiers
Binding: Modifier type Codes (example)
..... coding Σ1..1CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... version Σ1..1stringVersion of the system - if relevant
...... code Σ1..1codeSymbol in syntax defined by the system
.... serviced[x] 0..1date, PeriodDate or dates of Service
.... locationCodeableConcept 0..1CodeableConceptPlace of service
Binding: Example Service Place Codes (example)
..... bluebutton-carrier-prvdr-state-cd-extension 1..1CodingNCH Provider SSA State Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prvdr-state-cd-extension
Binding: NCH Provider SSA State Code (required)
..... bluebutton-carrier-prvdr-zip-extension 1..1CodingCarrier Line Performing Provider ZIP Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-prvdr-zip-extension
..... bluebutton-carrier-carr-line-prcng-lclty-cd-extension 1..1CodingCarrier Line Pricing Locality Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-prcng-lclty-cd-extension
Binding: Carrier Line Pricing Locality Code (required)
..... bluebutton-carrier-carr-line-clia-lab-num-extension 1..1IdentifierClinical Laboratory Improvement Amendments (CLIA) monitored laboratory number
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-line-clia-lab-num-extension
..... coding Σ0..*CodingCode defined by a terminology system
...... system Σ1..1uriIdentity of the terminology system
...... code Σ1..1codeSymbol in syntax defined by the system
...... display Σ1..1stringRepresentation defined by the system
.... quantity 0..1SimpleQuantityCount of Products or Services
..... value Σ0..1decimalNumerical value (with implicit precision)
.... adjudication 0..*BackboneElementAdjudication details
..... bluebutton-carrier-line-pmt-80-100-cd-extension 1..1CodingLine Payment 80% / 100% Code
URL: https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-line-pmt-80-100-cd-extension
Binding: Line Payment 80% / 100% Code (required)
..... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
..... category 1..1CodeableConceptAdjudication category such as co-pay, eligible, benefit, etc.
Binding: Adjudication Value Codes (example)
...... coding Σ0..*CodingCode defined by a terminology system
....... system Σ1..1uriIdentity of the terminology system
....... code Σ1..1codeSymbol in syntax defined by the system
....... display Σ1..1stringRepresentation defined by the system
..... reason 0..1CodeableConceptExplanation of Adjudication outcome
Binding: Adjudication Reason Codes (example)
...... coding Σ0..*CodingCode defined by a terminology system
....... system Σ1..1uriIdentity of the terminology system
....... code Σ1..1codeSymbol in syntax defined by the system
....... display Σ1..1stringRepresentation defined by the system
..... amount 0..1MoneyMonetary amount
...... value Σ1..1decimalNumerical value (with implicit precision)
...... system ΣI1..1uriSystem that defines coded unit form
...... code Σ1..1codeCoded form of the unit
... payment 1..1BackboneElementPayment (if paid)
.... modifierExtension ?!Σ0..*ExtensionExtensions that cannot be ignored
.... amount 1..1MoneyPayable amount after adjustment
..... value Σ1..1decimalNumerical value (with implicit precision)
..... system ΣI1..1uriSystem that defines coded unit form

doco Documentation for this format

Downloads: StructureDefinition: (XML, JSON, CSV), Schema: XML Schematron