Blue Button 2.0 Implementation Guide

D.4.1.4 StructureDefinition: BluebuttonOutpatientClaim - Mappings

Mappings for the StructureDefinition-bluebutton-outpatient-claim Profile.

Mappings for W5 Mapping (https://bluebutton.cms.gov/assets/ig/w5)

BluebuttonOutpatientClaim
ExplanationOfBenefitfinancial.other
   identifierid
   statusstatus
   typeclass
   patientwho.focus
   billablePeriodwhen.done
   providerwho.source
   organizationwho.source
   facilitywhere
   careTeam
      providerwho.actor
   item
      servicedDate (servicedDate)when.done
      locationAddress (locationAddress)where

Mappings for Canadian Dental Association eclaims standard (http://www.cda-adc.ca/en/services/cdanet/)

BluebuttonOutpatientClaim
ExplanationOfBenefit
   patientC06,C07,C08, C05, C04
   providerB02
   organizationB02
   information
      codeF23
   insurance
   item
      sequenceF07
      serviceF06
      modifierF16 (required field for Oral) and F05
      servicedDate (servicedDate)F09
   payment

Mappings for HL7 v2 Mapping (http://hl7.org/v2)

BluebuttonOutpatientClaim
ExplanationOfBenefit
   identifierCX / EI (occasionally, more often EI maps to a resource id or a URL)
      systemCX.4 / EI-2-4
      valueCX.1 / EI.1
   typeCE/CNE/CWE
      codingCE/CNE/CWE subset one of the sets of component 1-3 or 4-6
         systemC*E.3
         codeC*E.1
         displayC*E.2 - but note this is not well followed
      textC*E.9. But note many systems use C*E.2 for this
   patient
   billablePeriodDR
      startDR.1
      endDR.2
   provider
      identifierCX / EI (occasionally, more often EI maps to a resource id or a URL)
   organization
      identifierCX / EI (occasionally, more often EI maps to a resource id or a URL)
   facility
      identifierCX / EI (occasionally, more often EI maps to a resource id or a URL)
   information
      categoryCE/CNE/CWE
         codingCE/CNE/CWE subset one of the sets of component 1-3 or 4-6
            systemC*E.3
            codeC*E.1
            displayC*E.2 - but note this is not well followed
      codeCE/CNE/CWE
         codingCE/CNE/CWE subset one of the sets of component 1-3 or 4-6
            systemC*E.3
            codeC*E.1
            displayC*E.2 - but note this is not well followed
   careTeam
      provider
         identifierCX / EI (occasionally, more often EI maps to a resource id or a URL)
      roleCE/CNE/CWE
         codingCE/CNE/CWE subset one of the sets of component 1-3 or 4-6
            systemC*E.3
            codeC*E.1
            displayC*E.2 - but note this is not well followed
   diagnosis
      diagnosis[x]CE/CNE/CWE
      typeCE/CNE/CWE
         codingCE/CNE/CWE subset one of the sets of component 1-3 or 4-6
            systemC*E.3
            codeC*E.1
      packageCodeCE/CNE/CWE
         codingCE/CNE/CWE subset one of the sets of component 1-3 or 4-6
            systemC*E.3
            codeC*E.1
   procedure
      procedure[x]CE/CNE/CWE
   insuranceCoverage
      coverage
   item
      revenueCE/CNE/CWE
         codingCE/CNE/CWE subset one of the sets of component 1-3 or 4-6
            systemC*E.3
            codeC*E.1
      serviceCE/CNE/CWE
         codingCE/CNE/CWE subset one of the sets of component 1-3 or 4-6
            systemC*E.3
            versionC*E.7
            codeC*E.1
      modifierCE/CNE/CWE
         codingCE/CNE/CWE subset one of the sets of component 1-3 or 4-6
            systemC*E.3
            codeC*E.1
      locationAddress (locationAddress)CE/CNE/CWE
         stateXAD.4
      quantitySN (see also Range) or CQ
         valueSN.2 / CQ - N/A
      adjudication
         categoryCE/CNE/CWE
            codingCE/CNE/CWE subset one of the sets of component 1-3 or 4-6
               systemC*E.3
               codeC*E.1
               displayC*E.2 - but note this is not well followed
         reasonCE/CNE/CWE
            codingCE/CNE/CWE subset one of the sets of component 1-3 or 4-6
               systemC*E.3
               codeC*E.1
         amountSN (see also Range) or CQ
            valueSN.2 / CQ - N/A
            system(see OBX.6 etc.) / CQ.2
            code(see OBX.6 etc.) / CQ.2
   totalCostSN (see also Range) or CQ
      valueSN.2 / CQ - N/A
      system(see OBX.6 etc.) / CQ.2
      code(see OBX.6 etc.) / CQ.2
   payment
      amountSN (see also Range) or CQ
         valueSN.2 / CQ - N/A
         system(see OBX.6 etc.) / CQ.2

Mappings for RIM Mapping (http://hl7.org/v3)

BluebuttonOutpatientClaim
ExplanationOfBenefitEntity. Role, or Act
   idn/a
   extensionn/a
   extension (outpatient-nch-profnl-cmpnt-chrg-amt-extension)n/a
   extension (outpatient-nch-bene-ptb-ddctbl-amt-extension)n/a
   extension (outpatient-nch-bene-ptb-coinsrnc-amt-extension)n/a
   extension (outpatient-clm-op-prvrd-pmt-amt-extension)n/a
   extension (outpatient-clm-op-bene-pmt-amt-extension)n/a
   extension (outpatient-nch-bene-blood-ddctbl-lblty-am-extension)n/a
   extension (outpatient-clm-mdcr-non-pmt-rsn-cd-extension)n/a
   extension (outpatient-prpayamt-extension)n/a
   extension (outpatient-fi-num-extension)n/a
   modifierExtensionn/a
   identifiern/a
      extensionn/a
      systemn/a
      valuen/a
   statusn/a
   typen/a
      extensionn/a
      codingn/a
         extensionn/a
         systemn/a
         coden/a
         displayn/a
      textn/a
   patientn/a
      extensionn/a
      referencen/a
   billablePeriodn/a
      extensionn/a
      extension (outpatient-claim-query-cd-extension)n/a
      startn/a
      endn/a
   providern/a
      extensionn/a
      identifiern/a
   organizationn/a
      extensionn/a
      identifiern/a
   facilityn/a
      extensionn/a
      extension (outpatient-clm-fac-type-cd-extension)n/a
      identifiern/a
   informationn/a
      extensionn/a
      modifierExtensionn/a
      sequencen/a
      categoryn/a
         extensionn/a
         codingn/a
            extensionn/a
            systemn/a
            coden/a
            displayn/a
      coden/a
         extensionn/a
         codingn/a
            extensionn/a
            systemn/a
            coden/a
            displayn/a
      value[x]n/a
   careTeamn/a
      extensionn/a
      modifierExtensionn/a
      sequencen/a
      providern/a
         extensionn/a
         identifiern/a
      rolen/a
         extensionn/a
         codingn/a
            extensionn/a
            systemn/a
            coden/a
            displayn/a
   diagnosisn/a
      extensionn/a
      modifierExtensionn/a
      sequencen/a
      diagnosis[x]n/a
      typen/a
         extensionn/a
         codingn/a
            extensionn/a
            systemn/a
            coden/a
      packageCoden/a
         extensionn/a
         codingn/a
            extensionn/a
            systemn/a
            coden/a
   proceduren/a
      extensionn/a
      modifierExtensionn/a
      sequencen/a
      daten/a
      procedure[x]n/a
   insurancen/a
      extensionn/a
      modifierExtensionn/a
      coveragen/a
         extensionn/a
         referencen/a
   itemn/a
      extensionn/a
      extension (outpatient-rev-cntr-ndc-qty-extension)n/a
      modifierExtensionn/a
      sequencen/a
      careTeamLinkIdn/a
      revenuen/a
         extensionn/a
         extension (outpatient-rev-cntr-stus-ind-cd-extension)n/a
         codingn/a
            extensionn/a
            systemn/a
            coden/a
      servicen/a
         extensionn/a
         extension (outpatient-rev-cntr-ide-ndc-upc-num-extension)n/a
         codingn/a
            extensionn/a
            systemn/a
            versionn/a
            coden/a
      modifiern/a
         extensionn/a
         codingn/a
            extensionn/a
            systemn/a
            coden/a
      servicedDate (servicedDate)n/a
         extensionn/a
      locationAddress (locationAddress)n/a
         extensionn/a
         staten/a
      quantityn/a
         extensionn/a
         valuen/a
      adjudicationn/a
         extensionn/a
         modifierExtensionn/a
         categoryn/a
            extensionn/a
            codingn/a
               extensionn/a
               systemn/a
               coden/a
               displayn/a
         reasonn/a
            extensionn/a
            codingn/a
               extensionn/a
               systemn/a
               coden/a
         amountn/a
            extensionn/a
            valuen/a
            systemn/a
            coden/a
   totalCostn/a
      extensionn/a
      valuen/a
      systemn/a
      coden/a
   paymentn/a
      extensionn/a
      modifierExtensionn/a
      amountn/a
         extensionn/a
         valuen/a
         systemn/a