carin_for_blue_button_test_kit 0.15.1 → 0.15.2

This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
Files changed (87) hide show
  1. checksums.yaml +4 -4
  2. data/lib/carin_for_blue_button_test_kit/capability_statement/tests/instantiates_test.rb +14 -15
  3. data/lib/carin_for_blue_button_test_kit/capability_statement/tests/json_support_test.rb +0 -1
  4. data/lib/carin_for_blue_button_test_kit/client/v2.0.0/c4bb_client_test_suite.rb +14 -0
  5. data/lib/carin_for_blue_button_test_kit/client/v2.0.0/claim_data_request_tests/client_claims_data_attestation_test.rb +2 -2
  6. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/authentication.rb +30 -0
  7. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/last_updated.rb +31 -0
  8. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/must_support_absent_reason.rb +26 -0
  9. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/must_support_display.rb +26 -0
  10. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/must_support_missing.rb +27 -0
  11. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client.rb +25 -0
  12. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/00_authorization_group/attestation_test_requirement_48.rb +50 -0
  13. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/00_authorization_group/attestation_test_requirement_60.rb +48 -0
  14. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/00_authorization_group/attestation_test_requirement_97.rb +41 -0
  15. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/00_authorization_group.rb +15 -0
  16. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/01_must_support_group/attestation_test_requirement_10.rb +26 -0
  17. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/01_must_support_group/attestation_test_requirement_2.rb +29 -0
  18. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/01_must_support_group/attestation_test_requirement_5.rb +29 -0
  19. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/01_must_support_group/attestation_test_requirement_7.rb +30 -0
  20. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/01_must_support_group/attestation_test_requirement_9.rb +26 -0
  21. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/01_must_support_group.rb +19 -0
  22. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/03_eob_group/attestation_test_requirement_105.rb +29 -0
  23. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/03_eob_group/attestation_test_requirement_108.rb +29 -0
  24. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/03_eob_group/attestation_test_requirement_115.rb +24 -0
  25. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/03_eob_group/attestation_test_requirement_116.rb +30 -0
  26. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/03_eob_group/attestation_test_requirement_118.rb +31 -0
  27. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/03_eob_group/attestation_test_requirement_119.rb +31 -0
  28. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/03_eob_group/attestation_test_requirement_120.rb +29 -0
  29. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/03_eob_group/attestation_test_requirement_124.rb +38 -0
  30. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/03_eob_group.rb +25 -0
  31. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/04_eob_inpatient_group/attestation_test_requirement_130.rb +29 -0
  32. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/04_eob_inpatient_group/attestation_test_requirement_132.rb +27 -0
  33. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/04_eob_inpatient_group.rb +13 -0
  34. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/05_eob_outpatient_group/attestation_test_requirement_156.rb +28 -0
  35. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/05_eob_outpatient_group/attestation_test_requirement_157.rb +33 -0
  36. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/05_eob_outpatient_group.rb +13 -0
  37. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group/attestation_test_requirement_144.rb +33 -0
  38. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group/attestation_test_requirement_148.rb +29 -0
  39. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group/attestation_test_requirement_149.rb +27 -0
  40. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group/attestation_test_requirement_150.rb +29 -0
  41. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group/attestation_test_requirement_151.rb +27 -0
  42. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group/attestation_test_requirement_152.rb +29 -0
  43. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group/attestation_test_requirement_153.rb +31 -0
  44. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group.rb +23 -0
  45. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/07_eob_pharmacy_group/attestation_test_requirement_161.rb +27 -0
  46. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/07_eob_pharmacy_group/attestation_test_requirement_162.rb +27 -0
  47. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/07_eob_pharmacy_group/attestation_test_requirement_163.rb +27 -0
  48. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/07_eob_pharmacy_group/attestation_test_requirement_164.rb +25 -0
  49. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/07_eob_pharmacy_group/attestation_test_requirement_165.rb +27 -0
  50. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/07_eob_pharmacy_group.rb +19 -0
  51. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/08_eob_nonclinician_group/attestation_test_requirement_168_170.rb +29 -0
  52. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/08_eob_nonclinician_group/attestation_test_requirement_173.rb +29 -0
  53. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/08_eob_nonclinician_group.rb +13 -0
  54. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/09_organization_group/attestation_test_requirement_177.rb +29 -0
  55. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/09_organization_group/attestation_test_requirement_178.rb +27 -0
  56. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/09_organization_group.rb +12 -0
  57. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/10_practitioner_group/attestation_test_requirement_186.rb +27 -0
  58. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/10_practitioner_group.rb +10 -0
  59. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/adjudication_amount.rb +38 -0
  60. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/amount_calculations.rb +69 -0
  61. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/attestation_test_requirement_19.rb +27 -0
  62. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/attestation_test_requirement_28.rb +26 -0
  63. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/attestation_test_requirement_99.rb +26 -0
  64. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/coverage_reference_resource.rb +31 -0
  65. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/licensing.rb +33 -0
  66. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/meta_lastupdated.rb +46 -0
  67. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group.rb +24 -0
  68. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server.rb +37 -0
  69. data/lib/carin_for_blue_button_test_kit/generated/v1.1.0/c4bb_test_suite.rb +2 -0
  70. data/lib/carin_for_blue_button_test_kit/generated/v2.0.0/c4bb_test_suite.rb +20 -2
  71. data/lib/carin_for_blue_button_test_kit/generated/v2.0.0-dev-nonfinancial/c4bb_test_suite.rb +8 -0
  72. data/lib/carin_for_blue_button_test_kit/generator/suite_generator.rb +1 -1
  73. data/lib/carin_for_blue_button_test_kit/generator/templates/suite.rb.erb +21 -1
  74. data/lib/carin_for_blue_button_test_kit/requirements/{carin-for-blue-button-test-kit_requirements.csv → carin_for_blue_button_test_kit_requirements.csv} +198 -198
  75. data/lib/carin_for_blue_button_test_kit/requirements/generated/c4bb_v110_requirements_coverage.csv +1 -0
  76. data/lib/carin_for_blue_button_test_kit/requirements/generated/c4bb_v200_client_requirements_coverage.csv +47 -0
  77. data/lib/carin_for_blue_button_test_kit/requirements/generated/{carin-for-blue-button-test-kit_requirements_coverage.csv → c4bb_v200_requirements_coverage.csv} +156 -190
  78. data/lib/carin_for_blue_button_test_kit/requirements/generated/c4bb_v200devnonfinancial_requirements_coverage.csv +244 -0
  79. data/lib/carin_for_blue_button_test_kit/requirements/hl7.fhir.us.carin-bb_2.0.0_reqs.xlsx +0 -0
  80. data/lib/carin_for_blue_button_test_kit/version.rb +2 -2
  81. data/lib/carin_for_blue_button_test_kit.rb +0 -1
  82. metadata +77 -15
  83. data/lib/carin_for_blue_button_test_kit/requirements/carin-for-blue-button-test-kit_out_of_scope_requirements.csv +0 -68
  84. data/lib/inferno_requirements_tools/ext/inferno_core/runnable.rb +0 -22
  85. data/lib/inferno_requirements_tools/rake/rakefile_template +0 -31
  86. data/lib/inferno_requirements_tools/tasks/requirements_coverage.rb +0 -284
  87. data/lib/requirements_config.yaml +0 -17
data/lib/carin_for_blue_button_test_kit/requirements/{carin-for-blue-button-test-kit_requirements.csv → carin_for_blue_button_test_kit_requirements.csv} RENAMED
@@ -1,330 +1,330 @@
1
- Req Set,ID,URL,Requirement,Conformance,Actor,Sub-Requirement(s),Conditionality
2
- hl7.fhir.us.carin-bb_2.0.0,1,https://hl7.org/fhir/us/carin-bb/STU2/Background.html#smart-application-launch,The CARIN IG for Blue Button® requires the use of the SMART App Launch Framework’s standalone launch sequence as it will clarify that applications maintain a patient context for the duration of the connection.,SHALL,Health Plan/Consumer,,false
1
+ Req Set,ID,URL,Requirement,Conformance,Actors,Sub-Requirement(s),Conditionality,Not Tested Reason,Not Tested Details
2
+ hl7.fhir.us.carin-bb_2.0.0,1,https://hl7.org/fhir/us/carin-bb/STU2/Background.html#smart-application-launch,The CARIN IG for Blue Button® requires the use of the SMART App Launch Framework’s standalone launch sequence as it will clarify that applications maintain a patient context for the duration of the connection.,SHALL,"Health Plan, Consumer",,false,,
3
3
  hl7.fhir.us.carin-bb_2.0.0,2,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,"When querying and reading CARIN IG for Blue Button® Profiles, *Must Support* on any profile data element SHALL be interpreted as follows: ...
4
4
 
5
- Health Plan API actors SHALL be capable of populating all data elements the payer maintains as part of the query results as specified by the CARINBlueButtonHealthPlanAPICapabilityStatement.",SHALL,Health Plan,,false
6
- hl7.fhir.us.carin-bb_2.0.0,3,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,[*Must Support* on profile data elements means] Consumer App actors SHALL be capable of processing resource instances containing the data elements without generating an error or causing the application to fail.,SHALL,Consumer,,false
7
- hl7.fhir.us.carin-bb_2.0.0,4,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,[*Must Support* on profile data elements means] Consumer App actors SHALL be capable of displaying the data elements for human use.,SHALL,Consumer,,false
5
+ Health Plan API actors SHALL be capable of populating all data elements the payer maintains as part of the query results as specified by the CARINBlueButtonHealthPlanAPICapabilityStatement.",SHALL,Health Plan,,false,,
6
+ hl7.fhir.us.carin-bb_2.0.0,3,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,[*Must Support* on profile data elements means] Consumer App actors SHALL be capable of processing resource instances containing the data elements without generating an error or causing the application to fail.,SHALL,Consumer,,false,,
7
+ hl7.fhir.us.carin-bb_2.0.0,4,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,[*Must Support* on profile data elements means] Consumer App actors SHALL be capable of displaying the data elements for human use.,SHALL,Consumer,,false,,
8
8
  hl7.fhir.us.carin-bb_2.0.0,5,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,"When querying and reading CARIN IG for Blue Button® Profiles, *Must Support* on any profile data element SHALL be interpreted as follows:...
9
9
 
10
- In situations where information on a particular data element is not present and the reason for absence is unknown, Health Plan API actors SHALL NOT include the data elements in the resource instance returned as part of the query results.",SHALL NOT,Health Plan,,true
11
- hl7.fhir.us.carin-bb_2.0.0,6,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,"[*Must Support* on profile data elements means w]hen querying Health Plan API actors, Consumer App actors SHALL interpret missing data elements within resource instances as data not present in the Health Plan API actors system.",SHALL,Consumer,,false
10
+ In situations where information on a particular data element is not present and the reason for absence is unknown, Health Plan API actors SHALL NOT include the data elements in the resource instance returned as part of the query results.",SHALL NOT,Health Plan,,true,,
11
+ hl7.fhir.us.carin-bb_2.0.0,6,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,"[*Must Support* on profile data elements means w]hen querying Health Plan API actors, Consumer App actors SHALL interpret missing data elements within resource instances as data not present in the Health Plan API actors system.",SHALL,Consumer,,false,,
12
12
  hl7.fhir.us.carin-bb_2.0.0,7,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,"When querying and reading CARIN IG for Blue Button® Profiles, *Must Support* on any profile data element SHALL be interpreted as follows: ...
13
13
 
14
- In situations where information on a particular data element is missing and the Health Plan API actor knows the precise reason for the absence of data, Health Plan API actors SHALL send the reason for the missing information using values (such as nullFlavors) from the value set where they exist or use the dataAbsentReason extension.",SHALL,Health Plan,,true
15
- hl7.fhir.us.carin-bb_2.0.0,8,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,[*Must Support* on profile data elements means] Consumer App actors SHALL be able to process resource instances containing data elements asserting missing information.,SHALL,Consumer,,false
16
- hl7.fhir.us.carin-bb_2.0.0,9,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#missing-data,"If the source system does not have data for a *Must Support* data element with minimum cardinality = 0, the data element is omitted from the resource.",SHALL,Health Plan,,true
17
- hl7.fhir.us.carin-bb_2.0.0,10,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#missing-data,"If the source system does not have data for a required data element (in other words, where the minimum cardinality is > 0), follow guidance defined in the core FHIR specification and summarized in the US Core.",SHALL,Health Plan,"hl7.fhir.us.core_7.0.0,hl7.fhir_4.0.1",true
14
+ In situations where information on a particular data element is missing and the Health Plan API actor knows the precise reason for the absence of data, Health Plan API actors SHALL send the reason for the missing information using values (such as nullFlavors) from the value set where they exist or use the dataAbsentReason extension.",SHALL,Health Plan,,true,,
15
+ hl7.fhir.us.carin-bb_2.0.0,8,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,[*Must Support* on profile data elements means] Consumer App actors SHALL be able to process resource instances containing data elements asserting missing information.,SHALL,Consumer,,false,,
16
+ hl7.fhir.us.carin-bb_2.0.0,9,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#missing-data,"If the source system does not have data for a *Must Support* data element with minimum cardinality = 0, the data element is omitted from the resource.",SHALL,Health Plan,,true,,
17
+ hl7.fhir.us.carin-bb_2.0.0,10,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#missing-data,"If the source system does not have data for a required data element (in other words, where the minimum cardinality is > 0), follow guidance defined in the core FHIR specification and summarized in the US Core.",SHALL,Health Plan,,true,,
18
18
  hl7.fhir.us.carin-bb_2.0.0,11,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#conformance-to-us-core-profiles,"Any actor acting as a Health Plan API actor in this IG SHALL:…
19
19
 
20
- Be able to populate all profile data elements that have a minimum cardinality >= 1 and/or flagged as *Must Support* as defined by that profiles StructureDefinition.",SHALL,Health Plan,,false
20
+ Be able to populate all profile data elements that have a minimum cardinality >= 1 and/or flagged as *Must Support* as defined by that profiles StructureDefinition.",SHALL,Health Plan,,false,,
21
21
  hl7.fhir.us.carin-bb_2.0.0,12,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#conformance-to-us-core-profiles,"Any actor acting as a Health Plan API actor in this IG SHALL:…
22
22
 
23
- Conform to the US Core Health Plan Capability Statement expectations for that profile's type.",SHALL,Health Plan,,false
24
- hl7.fhir.us.carin-bb_2.0.0,13,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#conformance-to-us-core-profiles,Any actor acting [as] a FHIR Client in this IG SHALL … [b]e able to process and retain all profile data elements that have a minimum cardinality >= 1 and/or flagged as Must Support as defined by that profiles StructureDefinition.,SHALL,Consumer,,false
25
- hl7.fhir.us.carin-bb_2.0.0,14,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#conformance-to-us-core-profiles,Any actor acting [as] a FHIR Client in this IG SHALL … [c]onform to the US Core Client Capability Statement expectations for that profiles type.,SHALL,Consumer,,false
26
- hl7.fhir.us.carin-bb_2.0.0,15,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#profiling-constraints,"Data element that are not part of this scope have not been constrained out, and as such, may be included by the Health Plan API.",MAY,Health Plan,,false
27
- hl7.fhir.us.carin-bb_2.0.0,16,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#profiling-constraints,"If a Health Plan API includes additional information, there SHALL be no expectation that client applications support the data in any way in order to be conformant with this specification.",SHALL NOT,Consumer,,true
28
- hl7.fhir.us.carin-bb_2.0.0,17,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#capabilitystatement-Health Plan-requirement,Health Plans claiming conformance to this guide SHALL include a CapabilityStatement that has a CapabilityStatement.instantiates with a URL of http://hl7.org/fhir/us/carin-bb/CapabilityStatement/c4bb or a URL to the appropriate version of the CapabilityStatement.,SHALL,Health Plan,,false
29
- hl7.fhir.us.carin-bb_2.0.0,18,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,payers **MAY** choose to provide a concept text `[CodeableConcept].text` or the coding display `[CodeableConcept].coding.display.`,MAY,Health Plan,,false
30
- hl7.fhir.us.carin-bb_2.0.0,19,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"If the ‘display’ element is populated, the string used in `display` **SHALL** be one of the display strings defined for that code by the code system (code systems may define multiple display strings for a single code).",SHALL,Health Plan,,true
31
- hl7.fhir.us.carin-bb_2.0.0,20,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"If the code description available is not known to be an exact match of a display string defined by the code system, the `[CodeableConcept].text` should be used in place of the `[CodeableConcept].coding.display`.",SHOULD,Health Plan,,true
32
- hl7.fhir.us.carin-bb_2.0.0,21,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,Payers **MAY** choose to also provide resource level text to enable consumers apps to render resources in a manner that the payer would like to have the data presented.,MAY,Health Plan,,false
33
- hl7.fhir.us.carin-bb_2.0.0,22,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,The `[Resource].text` is a Narrative datatype that has a `div` element that is an xhtml datatype. This element **MAY** be used to provide an easily renderable version of the resource that is meant for human viewing.,MAY,Health Plan,,false
34
- hl7.fhir.us.carin-bb_2.0.0,23,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,Payers may also provide additional data elements beyond what is in this guide.,MAY,Health Plan,,false
35
- hl7.fhir.us.carin-bb_2.0.0,24,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"Payers SHOULD include descriptions of the data elements they provide, particularly for data elements not covered in this guide",SHOULD,Health Plan,,false
36
- hl7.fhir.us.carin-bb_2.0.0,25,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"As part of their API documentation, Payers … may consider providing a display mapping like can be found in the [Example Printed Explanation Of Benefit Mapping](http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#example-printed-eob-mapping) section of this implementation guide.",MAY,Health Plan,,false
37
- hl7.fhir.us.carin-bb_2.0.0,26,http://hl7.org/fhir/us/carin-bb/STU2/Common_Payer_Consumer_Data_Set.html#common-payer-consumer-data-set-cpcds,The Common Payer Consumer Data Set (CPCDS)… The CPCDS data elements can be stored and queried as profiled FHIR resources.,DEPRECATED,Health Plan,,false
38
- hl7.fhir.us.carin-bb_2.0.0,27,http://hl7.org/fhir/us/carin-bb/STU2/Common_Payer_Consumer_Data_Set.html#common-payer-consumer-data-set-cpcds,The Common Payer Consumer Data Set (CPCDS)… [The CPCDS data elements] define key payer financial health data that SHALL be accessible and available to through standards-based APIs.,SHALL,Health Plan,,false
39
- hl7.fhir.us.carin-bb_2.0.0,28,http://hl7.org/fhir/us/carin-bb/STU2/Common_Payer_Consumer_Data_Set.html#common-payer-consumer-data-set-cpcds,"The Common Payer Consumer Data Set (CPCDS)… Data SHALL conform to specified profiles, vocabulary standards and code sets.",SHALL,Health Plan,,false
40
- hl7.fhir.us.carin-bb_2.0.0,29,http://hl7.org/fhir/us/carin-bb/STU2/Common_Payer_Consumer_Data_Set.html#mapping-from-cpcds-to-fhir-resources,"Based on CPCDS, the mappings define the minimum mandatory elements, extensions and terminology requirements that must be present in the FHIR resource. Additional business rules are also specified.",DEPRECATED,Health Plan,,false
41
- hl7.fhir.us.carin-bb_2.0.0,30,http://hl7.org/fhir/us/carin-bb/STU2/Terminology_Licensure.html#access-to-licensed-code-systems,Implementers ... of this specification SHALL abide by the license requirements for each terminology content artifact utilized within a functioning implementation.,SHALL,Health Plan,,false
42
- hl7.fhir.us.carin-bb_2.0.0,31,http://hl7.org/fhir/us/carin-bb/STU2/Terminology_Licensure.html#access-to-licensed-code-systems,Terminology licenses SHALL be obtained from the Third Party IP owner for each code system and/or other specified artifact used.,SHALL,Health Plan,,false
23
+ Conform to the US Core Health Plan Capability Statement expectations for that profile's type.",SHALL,Health Plan,,false,,
24
+ hl7.fhir.us.carin-bb_2.0.0,13,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#conformance-to-us-core-profiles,Any actor acting [as] a FHIR Client in this IG SHALL … [b]e able to process and retain all profile data elements that have a minimum cardinality >= 1 and/or flagged as Must Support as defined by that profiles StructureDefinition.,SHALL,Consumer,,false,,
25
+ hl7.fhir.us.carin-bb_2.0.0,14,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#conformance-to-us-core-profiles,Any actor acting [as] a FHIR Client in this IG SHALL … [c]onform to the US Core Client Capability Statement expectations for that profiles type.,SHALL,Consumer,,false,,
26
+ hl7.fhir.us.carin-bb_2.0.0,15,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#profiling-constraints,"Data element that are not part of this scope have not been constrained out, and as such, may be included by the Health Plan API.",MAY,Health Plan,,false,,
27
+ hl7.fhir.us.carin-bb_2.0.0,16,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#profiling-constraints,"If a Health Plan API includes additional information, there SHALL be no expectation that client applications support the data in any way in order to be conformant with this specification.",SHALL NOT,Consumer,,true,,
28
+ hl7.fhir.us.carin-bb_2.0.0,17,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#capabilitystatement-Health Plan-requirement,Health Plans claiming conformance to this guide SHALL include a CapabilityStatement that has a CapabilityStatement.instantiates with a URL of http://hl7.org/fhir/us/carin-bb/CapabilityStatement/c4bb or a URL to the appropriate version of the CapabilityStatement.,SHALL,Health Plan,,false,,
29
+ hl7.fhir.us.carin-bb_2.0.0,18,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,payers **MAY** choose to provide a concept text `[CodeableConcept].text` or the coding display `[CodeableConcept].coding.display.`,MAY,Health Plan,,false,,
30
+ hl7.fhir.us.carin-bb_2.0.0,19,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"If the ‘display’ element is populated, the string used in `display` **SHALL** be one of the display strings defined for that code by the code system (code systems may define multiple display strings for a single code).",SHALL,Health Plan,,true,,
31
+ hl7.fhir.us.carin-bb_2.0.0,20,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"If the code description available is not known to be an exact match of a display string defined by the code system, the `[CodeableConcept].text` should be used in place of the `[CodeableConcept].coding.display`.",SHOULD,Health Plan,,true,,
32
+ hl7.fhir.us.carin-bb_2.0.0,21,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,Payers **MAY** choose to also provide resource level text to enable consumers apps to render resources in a manner that the payer would like to have the data presented.,MAY,Health Plan,,false,,
33
+ hl7.fhir.us.carin-bb_2.0.0,22,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,The `[Resource].text` is a Narrative datatype that has a `div` element that is an xhtml datatype. This element **MAY** be used to provide an easily renderable version of the resource that is meant for human viewing.,MAY,Health Plan,,false,,
34
+ hl7.fhir.us.carin-bb_2.0.0,23,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,Payers may also provide additional data elements beyond what is in this guide.,MAY,Health Plan,,false,,
35
+ hl7.fhir.us.carin-bb_2.0.0,24,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"Payers SHOULD include descriptions of the data elements they provide, particularly for data elements not covered in this guide",SHOULD,Health Plan,,false,,
36
+ hl7.fhir.us.carin-bb_2.0.0,25,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"As part of their API documentation, Payers … may consider providing a display mapping like can be found in the [Example Printed Explanation Of Benefit Mapping](http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#example-printed-eob-mapping) section of this implementation guide.",MAY,Health Plan,,false,,
37
+ hl7.fhir.us.carin-bb_2.0.0,26,http://hl7.org/fhir/us/carin-bb/STU2/Common_Payer_Consumer_Data_Set.html#common-payer-consumer-data-set-cpcds,The Common Payer Consumer Data Set (CPCDS)… The CPCDS data elements can be stored and queried as profiled FHIR resources.,DEPRECATED,Health Plan,,false,,
38
+ hl7.fhir.us.carin-bb_2.0.0,27,http://hl7.org/fhir/us/carin-bb/STU2/Common_Payer_Consumer_Data_Set.html#common-payer-consumer-data-set-cpcds,The Common Payer Consumer Data Set (CPCDS)… [The CPCDS data elements] define key payer financial health data that SHALL be accessible and available to through standards-based APIs.,SHALL,Health Plan,,false,,
39
+ hl7.fhir.us.carin-bb_2.0.0,28,http://hl7.org/fhir/us/carin-bb/STU2/Common_Payer_Consumer_Data_Set.html#common-payer-consumer-data-set-cpcds,"The Common Payer Consumer Data Set (CPCDS)… Data SHALL conform to specified profiles, vocabulary standards and code sets.",SHALL,Health Plan,,false,,
40
+ hl7.fhir.us.carin-bb_2.0.0,29,http://hl7.org/fhir/us/carin-bb/STU2/Common_Payer_Consumer_Data_Set.html#mapping-from-cpcds-to-fhir-resources,"Based on CPCDS, the mappings define the minimum mandatory elements, extensions and terminology requirements that must be present in the FHIR resource. Additional business rules are also specified.",DEPRECATED,Health Plan,,false,,
41
+ hl7.fhir.us.carin-bb_2.0.0,30,http://hl7.org/fhir/us/carin-bb/STU2/Terminology_Licensure.html#access-to-licensed-code-systems,Implementers ... of this specification SHALL abide by the license requirements for each terminology content artifact utilized within a functioning implementation.,SHALL,Health Plan,,false,,
42
+ hl7.fhir.us.carin-bb_2.0.0,31,http://hl7.org/fhir/us/carin-bb/STU2/Terminology_Licensure.html#access-to-licensed-code-systems,Terminology licenses SHALL be obtained from the Third Party IP owner for each code system and/or other specified artifact used.,SHALL,Health Plan,,false,,
43
43
  hl7.fhir.us.carin-bb_2.0.0,32,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#search-parameters-required-by-this-implementation-guide,"Search Parameters Required By This Implementation Guide…
44
44
 
45
- ExplanationOfBenefit _id token GET [base]/ExplanationOfBenefit?_id=[id]",DEPRECATED,Health Plan,,false
45
+ ExplanationOfBenefit _id token GET [base]/ExplanationOfBenefit?_id=[id]",DEPRECATED,Health Plan,,false,,
46
46
  hl7.fhir.us.carin-bb_2.0.0,33,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#search-parameters-required-by-this-implementation-guide,"Search Parameters Required By This Implementation Guide…
47
47
 
48
- ExplanationOfBenefit _lastUpdated date GET [base]/ExplanationOfBenefit?_lastUpdated=[_lastUpdated]",DEPRECATED,Health Plan,,false
48
+ ExplanationOfBenefit _lastUpdated date GET [base]/ExplanationOfBenefit?_lastUpdated=[_lastUpdated]",DEPRECATED,Health Plan,,false,,
49
49
  hl7.fhir.us.carin-bb_2.0.0,34,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#search-parameters-required-by-this-implementation-guide,"Search Parameters Required By This Implementation Guide…
50
50
 
51
- ExplanationOfBenefit identifier token GET [base]/ExplanationOfBenefit?identifier=[system]|[code]",DEPRECATED,Health Plan,,false
51
+ ExplanationOfBenefit identifier token GET [base]/ExplanationOfBenefit?identifier=[system]|[code]",DEPRECATED,Health Plan,,false,,
52
52
  hl7.fhir.us.carin-bb_2.0.0,35,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#search-parameters-required-by-this-implementation-guide,"Search Parameters Required By This Implementation Guide…
53
53
 
54
- ExplanationOfBenefit patient reference GET [base]/ExplanationOfBenefit?patient=[patient]",DEPRECATED,Health Plan,,false
54
+ ExplanationOfBenefit patient reference GET [base]/ExplanationOfBenefit?patient=[patient]",DEPRECATED,Health Plan,,false,,
55
55
  hl7.fhir.us.carin-bb_2.0.0,36,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#search-parameters-required-by-this-implementation-guide,"Search Parameters Required By This Implementation Guide…
56
56
 
57
- ExplanationOfBenefit type token GET [base]/ExplanationOfBenefit?type=[system]|[code]",DEPRECATED,Health Plan,,false
57
+ ExplanationOfBenefit type token GET [base]/ExplanationOfBenefit?type=[system]|[code]",DEPRECATED,Health Plan,,false,,
58
58
  hl7.fhir.us.carin-bb_2.0.0,37,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#search-parameters-required-by-this-implementation-guide,"Search Parameters Required By This Implementation Guide…
59
59
 
60
- ExplanationOfBenefit service-date date GET [base]/ExplanationOfBenefit?service-date=[service-date]",DEPRECATED,Health Plan,,false
60
+ ExplanationOfBenefit service-date date GET [base]/ExplanationOfBenefit?service-date=[service-date]",DEPRECATED,Health Plan,,false,,
61
61
  hl7.fhir.us.carin-bb_2.0.0,38,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#search-parameters-required-by-this-implementation-guide,"Search Parameters Required By This Implementation Guide…
62
62
 
63
- ExplanationOfBenefit service-start-date date GET [base]/ExplanationOfBenefit?service-start-date=[service-start-date]",DEPRECATED,Health Plan,,false
63
+ ExplanationOfBenefit service-start-date date GET [base]/ExplanationOfBenefit?service-start-date=[service-start-date]",DEPRECATED,Health Plan,,false,,
64
64
  hl7.fhir.us.carin-bb_2.0.0,39,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#search-parameters-required-by-this-implementation-guide,"Search Parameters Required By This Implementation Guide…
65
65
 
66
- ExplanationOfBenefit billable-period-start date GET [base]/ExplanationOfBenefit?billable-period-start=[billable-period-start]",DEPRECATED,Health Plan,,false
66
+ ExplanationOfBenefit billable-period-start date GET [base]/ExplanationOfBenefit?billable-period-start=[billable-period-start]",DEPRECATED,Health Plan,,false,,
67
67
  hl7.fhir.us.carin-bb_2.0.0,40,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#coverage,"A Server SHALL be capable of supporting the following _includes:…
68
68
 
69
- Coverage:payor - GET [base]/Coverage?_include=Coverage:payor",DEPRECATED,Health Plan,,false
69
+ Coverage:payor - GET [base]/Coverage?_include=Coverage:payor",DEPRECATED,Health Plan,,false,,
70
70
  hl7.fhir.us.carin-bb_2.0.0,41,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#explanationofbenefit,"A Server SHALL be capable of supporting the following _includes:…
71
71
 
72
- ExplanationOfBenefit:patient - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:patient",DEPRECATED,Health Plan,,false
72
+ ExplanationOfBenefit:patient - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:patient",DEPRECATED,Health Plan,,false,,
73
73
  hl7.fhir.us.carin-bb_2.0.0,42,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#explanationofbenefit,"A Server SHALL be capable of supporting the following _includes:…
74
74
 
75
- ExplanationOfBenefit:provider - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:provider",DEPRECATED,Health Plan,,false
75
+ ExplanationOfBenefit:provider - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:provider",DEPRECATED,Health Plan,,false,,
76
76
  hl7.fhir.us.carin-bb_2.0.0,43,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#explanationofbenefit,"A Server SHALL be capable of supporting the following _includes:…
77
77
 
78
- ExplanationOfBenefit:care-team - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:care-team",DEPRECATED,Health Plan,,false
78
+ ExplanationOfBenefit:care-team - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:care-team",DEPRECATED,Health Plan,,false,,
79
79
  hl7.fhir.us.carin-bb_2.0.0,44,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#explanationofbenefit,"A Server SHALL be capable of supporting the following _includes:…
80
80
 
81
- ExplanationOfBenefit:coverage - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:coverage",DEPRECATED,Health Plan,,false
81
+ ExplanationOfBenefit:coverage - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:coverage",DEPRECATED,Health Plan,,false,,
82
82
  hl7.fhir.us.carin-bb_2.0.0,45,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#explanationofbenefit,"A Server SHALL be capable of supporting the following _includes:…
83
83
 
84
- ExplanationOfBenefit:insurer - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:insurer",DEPRECATED,Health Plan,,false
84
+ ExplanationOfBenefit:insurer - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:insurer",DEPRECATED,Health Plan,,false,,
85
85
  hl7.fhir.us.carin-bb_2.0.0,46,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#explanationofbenefit,"A Server SHALL be capable of supporting the following _includes:…
86
86
 
87
- ExplanationOfBenefit:payee - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:payee",DEPRECATED,Health Plan,,false
87
+ ExplanationOfBenefit:payee - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:payee",DEPRECATED,Health Plan,,false,,
88
88
  hl7.fhir.us.carin-bb_2.0.0,47,http://hl7.org/fhir/us/carin-bb/STU2/searchparameters.html#explanationofbenefit,"A Server SHALL be capable of supporting the following _includes:…
89
89
 
90
90
  ExplanationOfBenefit:* - GET [base]/ExplanationOfBenefit?[parameter=value]&_include=ExplanationOfBenefit:*
91
91
 
92
- Note: _include=ExplanationOfBenefit:* means, at minimum, the resources that are included as reference type search parameters for the ExplanationOfBenefit resource on the Health Plan. Health Plans claiming compliance to this guide will, at minimum, support the include of patient, provider, care-team, coverage, and insurer, and will support returning all of them in support ExplanationOfBenefit:*. This guide does not require all of these as search parameters, but are defined as part of the _include requirement. For example, the insurer search parameter is not required because in the context of the use case, it is anticipated there will ever be one insurer. It however must be returned in the _include=ExplanationOfBenefit:* results. The means in which this is done (including defining all of the _include as search parameters) is not defined by this guide.",DEPRECATED,Health Plan,,false
93
- hl7.fhir.us.carin-bb_2.0.0,48,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#general-considerations,"Members need to be able to direct the communication of this information through authenticated, authorized, and secure channels.",SHALL,Health Plan/Consumer,,false
94
- hl7.fhir.us.carin-bb_2.0.0,49,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#general-considerations,Exchange of this information needs to be protected with proper security and privacy protections to avoid malicious or unintentional exposure of such information.,SHALL,Health Plan/Consumer,,false
95
- hl7.fhir.us.carin-bb_2.0.0,50,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#general-considerations,All consumer-directed payer data exchanges must be appropriately secured in transit and access limited only to authorized individuals.,SHALL,Health Plan/Consumer,,false
96
- hl7.fhir.us.carin-bb_2.0.0,51,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#legal-and-regulatory-requirements,"Implementers must ensure that APIs fully and successfully implement privacy and security features such as, but not limited to, those required to comply with HIPAA privacy and security requirements and other applicable law protecting the privacy and security of protected health information.",SHALL,Health Plan,,false
92
+ Note: _include=ExplanationOfBenefit:* means, at minimum, the resources that are included as reference type search parameters for the ExplanationOfBenefit resource on the Health Plan. Health Plans claiming compliance to this guide will, at minimum, support the include of patient, provider, care-team, coverage, and insurer, and will support returning all of them in support ExplanationOfBenefit:*. This guide does not require all of these as search parameters, but are defined as part of the _include requirement. For example, the insurer search parameter is not required because in the context of the use case, it is anticipated there will ever be one insurer. It however must be returned in the _include=ExplanationOfBenefit:* results. The means in which this is done (including defining all of the _include as search parameters) is not defined by this guide.",DEPRECATED,Health Plan,,false,,
93
+ hl7.fhir.us.carin-bb_2.0.0,48,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#general-considerations,"Members need to be able to direct the communication of this information through authenticated, authorized, and secure channels.",SHALL,"Health Plan, Consumer",,false,,
94
+ hl7.fhir.us.carin-bb_2.0.0,49,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#general-considerations,Exchange of this information needs to be protected with proper security and privacy protections to avoid malicious or unintentional exposure of such information.,SHALL,"Health Plan, Consumer",,false,,
95
+ hl7.fhir.us.carin-bb_2.0.0,50,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#general-considerations,All consumer-directed payer data exchanges must be appropriately secured in transit and access limited only to authorized individuals.,SHALL,"Health Plan, Consumer",,false,,
96
+ hl7.fhir.us.carin-bb_2.0.0,51,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#legal-and-regulatory-requirements,"Implementers must ensure that APIs fully and successfully implement privacy and security features such as, but not limited to, those required to comply with HIPAA privacy and security requirements and other applicable law protecting the privacy and security of protected health information.",SHALL,Health Plan,,false,,
97
97
  hl7.fhir.us.carin-bb_2.0.0,52,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#securityprivacy-related-technologies-including-explicit-consent-and-security-labels,"1. While past ONC regulations did have optional rules for data labeling and consent directives, as of May 2020, ONC has elected to not establish rules for either data labeling and consent directives as part of the Final Rule for the 21st Century Cures Act.
98
98
  2. At present there is no explicit regulatory requirement for the use of these technologies in conjunction with this guide.
99
99
  3. However, to meet the statutes, regulations, and guiding principles above, consent directives and security labels MAY be considered and used.
100
- 4. Organizations which plan to take advantage of these additional capabilities are responsible for negotiating support for these mechanisms between trading partners. The FHIR implementation guide defining the recommended standard is the FHIR Data Segmentation for Privacy IG.",MAY,Health Plan/Consumer,,false
101
- hl7.fhir.us.carin-bb_2.0.0,53,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#security-considerations-and-guidance,"All implementers of the CARIN Consumer-Directed Payer Data Exchange Implementation Guide (IG) should follow the FHIR Security guidance, Security and Privacy Module, and the FHIR Implementer’s Safety Checklist guidance as defined in the FHIR standard where applicable and not otherwise superseded by this section of the IG.",SHOULD,Health Plan/Consumer,,false
102
- hl7.fhir.us.carin-bb_2.0.0,54,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#exchange-security,The exchange of information SHOULD use the current version...of Transport Level Security (TLS) as specified by the current release of NIST guidelines (SP 800-52).,SHOULD,Health Plan/Consumer,,false
103
- hl7.fhir.us.carin-bb_2.0.0,55,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#exchange-security,The exchange of information … SHALL use either current or the immediately prior release of Transport Level Security (TLS) as specified by the current release of NIST guidelines (SP 800-52).,SHALL,Health Plan,,false
104
- hl7.fhir.us.carin-bb_2.0.0,56,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#exchange-security,Implementers of this Implementation Guide SHOULD support SMART on FHIR Authorization best practices Transport Security section.,SHOULD,Health Plan/Consumer,,false
105
- hl7.fhir.us.carin-bb_2.0.0,57,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Implementations SHALL support the FHIR US Core [Patient Privacy and Security requirements](https://www.hl7.org/fhir/us/core/security.html),SHALL,Health Plan,hl7.fhir.us.core_7.0.0,false
106
- hl7.fhir.us.carin-bb_2.0.0,58,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server systems SHALL publish their authorization and token endpoints for discovery in accordance with the SMART App Launch framework and publicly publish the Well-Known Uniform Resource Identifiers (URIs) JSON file with scopes defined in the scopes_supported property.,SHALL,Health Plan,,false
107
- hl7.fhir.us.carin-bb_2.0.0,59,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Implementations SHOULD consider the SMART on FHIR Best Practices in Authorization found [here](https://docs.smarthealthit.org/authorization/best-practices/).,SHOULD,Health Plan/Consumer,,false
100
+ 4. Organizations which plan to take advantage of these additional capabilities are responsible for negotiating support for these mechanisms between trading partners. The FHIR implementation guide defining the recommended standard is the FHIR Data Segmentation for Privacy IG.",MAY,"Health Plan, Consumer",,false,,
101
+ hl7.fhir.us.carin-bb_2.0.0,53,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#security-considerations-and-guidance,"All implementers of the CARIN Consumer-Directed Payer Data Exchange Implementation Guide (IG) should follow the FHIR Security guidance, Security and Privacy Module, and the FHIR Implementer’s Safety Checklist guidance as defined in the FHIR standard where applicable and not otherwise superseded by this section of the IG.",SHOULD,"Health Plan, Consumer",,false,,
102
+ hl7.fhir.us.carin-bb_2.0.0,54,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#exchange-security,The exchange of information SHOULD use the current version...of Transport Level Security (TLS) as specified by the current release of NIST guidelines (SP 800-52).,SHOULD,"Health Plan, Consumer",,false,,
103
+ hl7.fhir.us.carin-bb_2.0.0,55,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#exchange-security,The exchange of information … SHALL use either current or the immediately prior release of Transport Level Security (TLS) as specified by the current release of NIST guidelines (SP 800-52).,SHALL,Health Plan,,false,,
104
+ hl7.fhir.us.carin-bb_2.0.0,56,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#exchange-security,Implementers of this Implementation Guide SHOULD support SMART on FHIR Authorization best practices Transport Security section.,SHOULD,"Health Plan, Consumer",,false,,
105
+ hl7.fhir.us.carin-bb_2.0.0,57,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Implementations SHALL support the FHIR US Core [Patient Privacy and Security requirements](https://www.hl7.org/fhir/us/core/security.html),SHALL,Health Plan,,false,,
106
+ hl7.fhir.us.carin-bb_2.0.0,58,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server systems SHALL publish their authorization and token endpoints for discovery in accordance with the SMART App Launch framework and publicly publish the Well-Known Uniform Resource Identifiers (URIs) JSON file with scopes defined in the scopes_supported property.,SHALL,Health Plan,,false,,
107
+ hl7.fhir.us.carin-bb_2.0.0,59,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Implementations SHOULD consider the SMART on FHIR Best Practices in Authorization found [here](https://docs.smarthealthit.org/authorization/best-practices/).,SHOULD,"Health Plan, Consumer",,false,,
108
108
  hl7.fhir.us.carin-bb_2.0.0,60,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"Server implementation SHALL support the following [“SMART Core Capabilities”](http://hl7.org/fhir/smart-app-launch/conformance/index.html#core-capabilities)...
109
109
 
110
- `launch-standalone`: support for SMART’s Standalone Launch mode",SHALL,Health Plan,,false
110
+ `launch-standalone`: support for SMART’s Standalone Launch mode",SHALL,Health Plan,,false,,
111
111
  hl7.fhir.us.carin-bb_2.0.0,61,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"Server implementation SHALL support the following [“SMART Core Capabilities”](http://hl7.org/fhir/smart-app-launch/conformance/index.html#core-capabilities)…
112
112
 
113
- `client-public`: support for SMART’s public Consumer profile (no Consumer authentication)",SHALL,Health Plan,,false
113
+ `client-public`: support for SMART’s public Consumer profile (no Consumer authentication)",SHALL,Health Plan,,false,,
114
114
  hl7.fhir.us.carin-bb_2.0.0,62,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"Server implementation SHALL support the following “SMART Core Capabilities”
115
115
  ...
116
- client-confidential-symmetric: support for SMART’s confidential client profile",SHALL,Health Plan,,false
116
+ client-confidential-symmetric: support for SMART’s confidential client profile",SHALL,Health Plan,,false,,
117
117
  hl7.fhir.us.carin-bb_2.0.0,63,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"Server implementation SHALL support the following [“SMART Core Capabilities”](http://hl7.org/fhir/smart-app-launch/conformance/index.html#core-capabilities)...
118
118
 
119
- `sso-openid-connect`: support for SMART’s OpenID Connect profile",SHALL,Health Plan,,false
119
+ `sso-openid-connect`: support for SMART’s OpenID Connect profile",SHALL,Health Plan,,false,,
120
120
  hl7.fhir.us.carin-bb_2.0.0,64,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"Server implementation SHALL support the following [“SMART Core Capabilities”](http://hl7.org/fhir/smart-app-launch/conformance/index.html#core-capabilities)...
121
121
 
122
- `context-standalone-patient`: support for patient-level launch context (requested by launch/patient scope, conveyed via patient token parameter)",SHALL,Health Plan,,false
122
+ `context-standalone-patient`: support for patient-level launch context (requested by launch/patient scope, conveyed via patient token parameter)",SHALL,Health Plan,,false,,
123
123
  hl7.fhir.us.carin-bb_2.0.0,65,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"Server implementation SHALL support the following [“SMART Core Capabilities”](http://hl7.org/fhir/smart-app-launch/conformance/index.html#core-capabilities)…
124
124
 
125
- `permission-offline`: support for refresh tokens (requested by offline_access scope)",SHALL,Health Plan,,false
125
+ `permission-offline`: support for refresh tokens (requested by offline_access scope)",SHALL,Health Plan,,false,,
126
126
  hl7.fhir.us.carin-bb_2.0.0,66,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"Server implementation SHALL support the following [“SMART Core Capabilities”](http://hl7.org/fhir/smart-app-launch/conformance/index.html#core-capabilities)…
127
127
 
128
- `permission-patient`: support for patient-level scopes (e.g. patient Observation.read)",SHALL,Health Plan,,false
128
+ `permission-patient`: support for patient-level scopes (e.g. patient Observation.read)",SHALL,Health Plan,,false,,
129
129
  hl7.fhir.us.carin-bb_2.0.0,67,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"Server implementation SHALL support the following [“SMART Core Capabilities”](http://hl7.org/fhir/smart-app-launch/conformance/index.html#core-capabilities)…
130
130
 
131
- `permission-user`: support for user-level scopes (e.g. user/Appointment.read)",SHALL,Health Plan,,false
132
- hl7.fhir.us.carin-bb_2.0.0,68,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … openid,SHALL,Health Plan,,false
133
- hl7.fhir.us.carin-bb_2.0.0,69,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … fhirUser,SHALL,Health Plan,,false
134
- hl7.fhir.us.carin-bb_2.0.0,70,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … launch/patient,SHALL,Health Plan,,false
135
- hl7.fhir.us.carin-bb_2.0.0,71,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/ExplanationOfBenefit.read,SHALL,Health Plan,,false
136
- hl7.fhir.us.carin-bb_2.0.0,72,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/Coverage.read,SHALL,Health Plan,,false
137
- hl7.fhir.us.carin-bb_2.0.0,73,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/Patient.read,SHALL,Health Plan,,false
138
- hl7.fhir.us.carin-bb_2.0.0,74,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/Organization.read,SHALL,Health Plan,,false
139
- hl7.fhir.us.carin-bb_2.0.0,75,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/Practitioner.read,SHALL,Health Plan,,false
140
- hl7.fhir.us.carin-bb_2.0.0,76,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/Coverage.read,SHALL,Health Plan,,false
141
- hl7.fhir.us.carin-bb_2.0.0,77,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … user/ExplanationOfBenefit.read,SHALL,Health Plan,,false
142
- hl7.fhir.us.carin-bb_2.0.0,78,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … user/Coverage.read,SHALL,Health Plan,,false
143
- hl7.fhir.us.carin-bb_2.0.0,79,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … user/Patient.read,SHALL,Health Plan,,false
144
- hl7.fhir.us.carin-bb_2.0.0,80,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … user/Organization.read,SHALL,Health Plan,,false
145
- hl7.fhir.us.carin-bb_2.0.0,81,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … user/Practitioner.read,SHALL,Health Plan,,false
146
- hl7.fhir.us.carin-bb_2.0.0,82,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"MAY support the [Security for Scalable Registration, Authentication, and Authorization 0.1.0](http://hl7.org/fhir/us/udap-security/2021Sep/) or later for registration of client applications and (authentication and authorization of client applications or users)",MAY,Health Plan,,false
147
- hl7.fhir.us.carin-bb_2.0.0,83,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"If UDAP is supported, then all Server systems and Client applications that can protect private cryptographic keys and all systems of record SHOULD support UDAP JWT-Based Consumer Authentication for the authentication of client applications using asymmetric cryptography.",SHOULD,Health Plan/Consumer,,true
148
- hl7.fhir.us.carin-bb_2.0.0,84,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#audit-logging-and-provenance,Relevant audit and provenance events SHALL be recorded.,SHALL,Health Plan,,false
149
- hl7.fhir.us.carin-bb_2.0.0,85,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#audit-logging-and-provenance,Server implementations SHOULD record IG related data access using the [AuditEvent](http://hl7.org/fhir/R4/auditevent.html) resource.,SHOULD,Health Plan,,false
150
- hl7.fhir.us.carin-bb_2.0.0,86,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#audit-logging-and-provenance,Server implementations SHOULD support the ability to directly record and/or enable Clients to assert (store) provenance associated with advance directive information using the [Provenance](http://hl7.org/fhir/R4/provenance.html) resource.,SHOULD,Health Plan,,false
151
- hl7.fhir.us.carin-bb_2.0.0,87,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#root,"The 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.",SHALL,Health Plan,,false
152
- hl7.fhir.us.carin-bb_2.0.0,88,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#root,"However, for other reference resources [than Coverage Reference Resource], payers MAY decide to provide either the data that was in effect as of the date of service or the current data.",MAY,Health Plan,,false
153
- hl7.fhir.us.carin-bb_2.0.0,89,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#root,"Payers SHALL provide the last time the data was updated or the date of creation in the payers system of record, whichever comes last.",SHALL,Health Plan,,false
154
- hl7.fhir.us.carin-bb_2.0.0,90,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#root,Apps will use the meta.lastUpdated values to determine if the reference resources are as of the current date or date of service.,SHALL,Consumer,,false
155
- hl7.fhir.us.carin-bb_2.0.0,91,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#title,"The 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.",SHALL,Health Plan,,false
156
- hl7.fhir.us.carin-bb_2.0.0,92,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#title,"However, for other reference resources [than Coverage Reference Resource], payers MAY decide to provide either the data that was in effect as of the date of service or the current data.",MAY,Health Plan,,false
157
- hl7.fhir.us.carin-bb_2.0.0,93,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#title,"Payers SHALL provide the last time the data was updated or the date of creation in the payers system of record, whichever comes last.",SHALL,Health Plan,,false
158
- hl7.fhir.us.carin-bb_2.0.0,94,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#title,Apps will use the meta.lastUpdated values to determine if the reference resources are as of the current date or date of service.,SHALL,Consumer,,false
159
- hl7.fhir.us.carin-bb_2.0.0,95,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHALL: … Support all profiles defined in this Implementation Guide.,SHALL,Health Plan,,false
160
- hl7.fhir.us.carin-bb_2.0.0,96,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHALL: … Implement the RESTful behavior according to the FHIR specification.,SHALL,Health Plan,,false
131
+ `permission-user`: support for user-level scopes (e.g. user/Appointment.read)",SHALL,Health Plan,,false,,
132
+ hl7.fhir.us.carin-bb_2.0.0,68,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … openid,SHALL,Health Plan,,false,,
133
+ hl7.fhir.us.carin-bb_2.0.0,69,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … fhirUser,SHALL,Health Plan,,false,,
134
+ hl7.fhir.us.carin-bb_2.0.0,70,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … launch/patient,SHALL,Health Plan,,false,,
135
+ hl7.fhir.us.carin-bb_2.0.0,71,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/ExplanationOfBenefit.read,SHALL,Health Plan,,false,,
136
+ hl7.fhir.us.carin-bb_2.0.0,72,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/Coverage.read,SHALL,Health Plan,,false,,
137
+ hl7.fhir.us.carin-bb_2.0.0,73,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/Patient.read,SHALL,Health Plan,,false,,
138
+ hl7.fhir.us.carin-bb_2.0.0,74,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/Organization.read,SHALL,Health Plan,,false,,
139
+ hl7.fhir.us.carin-bb_2.0.0,75,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/Practitioner.read,SHALL,Health Plan,,false,,
140
+ hl7.fhir.us.carin-bb_2.0.0,76,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … patient/Coverage.read,SHALL,Health Plan,,false,,
141
+ hl7.fhir.us.carin-bb_2.0.0,77,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … user/ExplanationOfBenefit.read,SHALL,Health Plan,,false,,
142
+ hl7.fhir.us.carin-bb_2.0.0,78,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … user/Coverage.read,SHALL,Health Plan,,false,,
143
+ hl7.fhir.us.carin-bb_2.0.0,79,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … user/Patient.read,SHALL,Health Plan,,false,,
144
+ hl7.fhir.us.carin-bb_2.0.0,80,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … user/Organization.read,SHALL,Health Plan,,false,,
145
+ hl7.fhir.us.carin-bb_2.0.0,81,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,Server implementations of this Implementation Guide SHALL support … the requested authorization scopes: … user/Practitioner.read,SHALL,Health Plan,,false,,
146
+ hl7.fhir.us.carin-bb_2.0.0,82,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"MAY support the [Security for Scalable Registration, Authentication, and Authorization 0.1.0](http://hl7.org/fhir/us/udap-security/2021Sep/) or later for registration of client applications and (authentication and authorization of client applications or users)",MAY,Health Plan,,false,,
147
+ hl7.fhir.us.carin-bb_2.0.0,83,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#authentication-and-authorization-requirements,"If UDAP is supported, then all Server systems and Client applications that can protect private cryptographic keys and all systems of record SHOULD support UDAP JWT-Based Consumer Authentication for the authentication of client applications using asymmetric cryptography.",SHOULD,"Health Plan, Consumer",,true,,
148
+ hl7.fhir.us.carin-bb_2.0.0,84,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#audit-logging-and-provenance,Relevant audit and provenance events SHALL be recorded.,SHALL,Health Plan,,false,,
149
+ hl7.fhir.us.carin-bb_2.0.0,85,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#audit-logging-and-provenance,Server implementations SHOULD record IG related data access using the [AuditEvent](http://hl7.org/fhir/R4/auditevent.html) resource.,SHOULD,Health Plan,,false,,
150
+ hl7.fhir.us.carin-bb_2.0.0,86,http://hl7.org/fhir/us/carin-bb/STU2/Security_And_Privacy_Considerations.html#audit-logging-and-provenance,Server implementations SHOULD support the ability to directly record and/or enable Clients to assert (store) provenance associated with advance directive information using the [Provenance](http://hl7.org/fhir/R4/provenance.html) resource.,SHOULD,Health Plan,,false,,
151
+ hl7.fhir.us.carin-bb_2.0.0,87,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#root,"The 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.",SHALL,Health Plan,,false,,
152
+ hl7.fhir.us.carin-bb_2.0.0,88,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#root,"However, for other reference resources [than Coverage Reference Resource], payers MAY decide to provide either the data that was in effect as of the date of service or the current data.",MAY,Health Plan,,false,,
153
+ hl7.fhir.us.carin-bb_2.0.0,89,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#root,"Payers SHALL provide the last time the data was updated or the date of creation in the payers system of record, whichever comes last.",SHALL,Health Plan,,false,,
154
+ hl7.fhir.us.carin-bb_2.0.0,90,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#root,Apps will use the meta.lastUpdated values to determine if the reference resources are as of the current date or date of service.,SHALL,Consumer,,false,,
155
+ hl7.fhir.us.carin-bb_2.0.0,91,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#title,"The 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.",SHALL,Health Plan,,false,,
156
+ hl7.fhir.us.carin-bb_2.0.0,92,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#title,"However, for other reference resources [than Coverage Reference Resource], payers MAY decide to provide either the data that was in effect as of the date of service or the current data.",MAY,Health Plan,,false,,
157
+ hl7.fhir.us.carin-bb_2.0.0,93,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#title,"Payers SHALL provide the last time the data was updated or the date of creation in the payers system of record, whichever comes last.",SHALL,Health Plan,,false,,
158
+ hl7.fhir.us.carin-bb_2.0.0,94,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#title,Apps will use the meta.lastUpdated values to determine if the reference resources are as of the current date or date of service.,SHALL,Consumer,,false,,
159
+ hl7.fhir.us.carin-bb_2.0.0,95,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHALL: … Support all profiles defined in this Implementation Guide.,SHALL,Health Plan,,false,,
160
+ hl7.fhir.us.carin-bb_2.0.0,96,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHALL: … Implement the RESTful behavior according to the FHIR specification.,SHALL,Health Plan,,false,Not Verifiable,Overly broad
161
161
  hl7.fhir.us.carin-bb_2.0.0,97,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,"The C4BB Server SHALL: … Return the following response classes:
162
162
  - (Status 400): invalid parameter
163
163
  - (Status 401/4xx): unauthorized request
164
164
  - (Status 403): insufficient scope
165
165
  - (Status 404): unknown resource
166
- - (Status 410): deleted resource.",SHALL,Health Plan,,false
167
- hl7.fhir.us.carin-bb_2.0.0,98,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHALL: … Support json source formats for all CARIN-BB interactions.,SHALL,Health Plan,,false
168
- hl7.fhir.us.carin-bb_2.0.0,99,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHALL: … Identify the CARIN-BB profiles supported as part of the FHIR meta.profile attribute for each instance.,SHALL,Health Plan,,false
169
- hl7.fhir.us.carin-bb_2.0.0,100,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHALL: … Support the searchParameters on each profile individually and in combination.,SHALL,Health Plan,,false
170
- hl7.fhir.us.carin-bb_2.0.0,101,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHOULD: Support xml source formats for all C4BB interactions.,SHOULD,Health Plan,,false
171
- hl7.fhir.us.carin-bb_2.0.0,102,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,"A Server SHALL reject any unauthorized requests by returning an HTTP 401 ""Unauthorized"", HTTP 403 ""Forbidden"", or HTTP 404 ""Not Found"" .",SHALL,Health Plan,,false
172
- hl7.fhir.us.carin-bb_2.0.0,103,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,Explanation of Benefits: Conformance Expectation SHALL,SHALL,Health Plan,,false
173
- hl7.fhir.us.carin-bb_2.0.0,104,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,"When an EOB references another resource (e.g., Patient or Practitioner), the reference may be versioned or versionless.",MAY,Health Plan,,false
174
- hl7.fhir.us.carin-bb_2.0.0,105,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,"Payers SHALL use versioned references whenever they maintain point-in-time data (data that was effective as of the date of service or date of admission on the claim),",SHALL,Health Plan,,false
175
- hl7.fhir.us.carin-bb_2.0.0,106,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,Payers... MAY use versionless references when they do not maintain versioned data.,MAY,Health Plan,,false
176
- hl7.fhir.us.carin-bb_2.0.0,107,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,Clients MAY request referenced resources as part of an EOB search (by supplying the _include parameter) or directly using read or vread.,MAY,Consumer,,false
177
- hl7.fhir.us.carin-bb_2.0.0,108,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,"Payers SHALL support both approaches, and SHALL return the same content for referenced resources in either case.",SHALL,Health Plan,,false
178
- hl7.fhir.us.carin-bb_2.0.0,109,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,"“:iterate"" should be used if you request to include Coverage:payor in the EOB response bundle, e.g. GET [base]/ExplanationOfBenefit?_id[parameter=value]&_include=ExplanationOfBenefit:coverage&_include:iterate=Coverage:payor.",SHOULD,Consumer,,false
179
- hl7.fhir.us.carin-bb_2.0.0,110,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#root,"All EOB instances should be from one of the four concrete EOB profiles defined in this Implementation Guide: Inpatient, Outpatient, Pharmacy, and Professional/NonClinician",SHOULD,Health Plan,,false
180
- hl7.fhir.us.carin-bb_2.0.0,111,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#other-payer,CPCDS modified the concept of primary payer to other payer to accommodate situations when multiple prior payers are involved. Each amount paid by the other payer should be listed separately.,SHOULD,Health Plan,,false
181
- hl7.fhir.us.carin-bb_2.0.0,112,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".meta.lastUpdated: Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last.",SHALL,Health Plan,,false
182
- hl7.fhir.us.carin-bb_2.0.0,113,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".status: value =Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required.",SHOULD,Health Plan,,false
183
- hl7.fhir.us.carin-bb_2.0.0,114,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.type Defines the Claims profiles. Values from Claim Type Codes are required;,SHALL,Health Plan,,false
184
- hl7.fhir.us.carin-bb_2.0.0,115,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.type Defines the Claims profiles…. .type SHALL NOT use a data absent reason.,SHALL NOT,Health Plan,,false
185
- hl7.fhir.us.carin-bb_2.0.0,116,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.insurer Same as insurance.coverage.organization. Party responsible for reimbursing the provider,SHALL,Health Plan,,false
186
- hl7.fhir.us.carin-bb_2.0.0,117,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.outcome: value = complete,SHALL,Health Plan,,false
166
+ - (Status 410): deleted resource.",SHALL,Health Plan,,false,,
167
+ hl7.fhir.us.carin-bb_2.0.0,98,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHALL: … Support json source formats for all CARIN-BB interactions.,SHALL,Health Plan,,false,,
168
+ hl7.fhir.us.carin-bb_2.0.0,99,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHALL: … Identify the CARIN-BB profiles supported as part of the FHIR meta.profile attribute for each instance.,SHALL,Health Plan,,false,,
169
+ hl7.fhir.us.carin-bb_2.0.0,100,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHALL: … Support the searchParameters on each profile individually and in combination.,SHALL,Health Plan,,false,,
170
+ hl7.fhir.us.carin-bb_2.0.0,101,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,The C4BB Server SHOULD: Support xml source formats for all C4BB interactions.,SHOULD,Health Plan,,false,,
171
+ hl7.fhir.us.carin-bb_2.0.0,102,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#behavior,"A Server SHALL reject any unauthorized requests by returning an HTTP 401 ""Unauthorized"", HTTP 403 ""Forbidden"", or HTTP 404 ""Not Found"" .",SHALL,Health Plan,,false,,
172
+ hl7.fhir.us.carin-bb_2.0.0,103,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,Explanation of Benefits: Conformance Expectation SHALL,SHALL,Health Plan,,false,,
173
+ hl7.fhir.us.carin-bb_2.0.0,104,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,"When an EOB references another resource (e.g., Patient or Practitioner), the reference may be versioned or versionless.",MAY,Health Plan,,false,,
174
+ hl7.fhir.us.carin-bb_2.0.0,105,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,"Payers SHALL use versioned references whenever they maintain point-in-time data (data that was effective as of the date of service or date of admission on the claim),",SHALL,Health Plan,,false,,
175
+ hl7.fhir.us.carin-bb_2.0.0,106,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,Payers... MAY use versionless references when they do not maintain versioned data.,MAY,Health Plan,,false,,
176
+ hl7.fhir.us.carin-bb_2.0.0,107,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,Clients MAY request referenced resources as part of an EOB search (by supplying the _include parameter) or directly using read or vread.,MAY,Consumer,,false,,
177
+ hl7.fhir.us.carin-bb_2.0.0,108,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,"Payers SHALL support both approaches, and SHALL return the same content for referenced resources in either case.",SHALL,Health Plan,,false,,
178
+ hl7.fhir.us.carin-bb_2.0.0,109,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,"“:iterate"" should be used if you request to include Coverage:payor in the EOB response bundle, e.g. GET [base]/ExplanationOfBenefit?_id[parameter=value]&_include=ExplanationOfBenefit:coverage&_include:iterate=Coverage:payor.",SHOULD,Consumer,,false,,
179
+ hl7.fhir.us.carin-bb_2.0.0,110,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#root,"All EOB instances should be from one of the four concrete EOB profiles defined in this Implementation Guide: Inpatient, Outpatient, Pharmacy, and Professional/NonClinician",SHOULD,Health Plan,,false,,
180
+ hl7.fhir.us.carin-bb_2.0.0,111,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#other-payer,CPCDS modified the concept of primary payer to other payer to accommodate situations when multiple prior payers are involved. Each amount paid by the other payer should be listed separately.,SHOULD,Health Plan,,false,,
181
+ hl7.fhir.us.carin-bb_2.0.0,112,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".meta.lastUpdated: Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last.",SHALL,Health Plan,,false,,
182
+ hl7.fhir.us.carin-bb_2.0.0,113,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".status: value =Expected values are active or cancelled. To comply with the CMS rule, draft EOBs are not required.",SHOULD,Health Plan,,false,,
183
+ hl7.fhir.us.carin-bb_2.0.0,114,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.type Defines the Claims profiles. Values from Claim Type Codes are required;,SHALL,Health Plan,,false,,
184
+ hl7.fhir.us.carin-bb_2.0.0,115,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.type Defines the Claims profiles…. .type SHALL NOT use a data absent reason.,SHALL NOT,Health Plan,,false,,
185
+ hl7.fhir.us.carin-bb_2.0.0,116,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.insurer Same as insurance.coverage.organization. Party responsible for reimbursing the provider,SHALL,Health Plan,,false,,
186
+ hl7.fhir.us.carin-bb_2.0.0,117,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.outcome: value = complete,SHALL,Health Plan,,false,,
187
187
  hl7.fhir.us.carin-bb_2.0.0,118,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".related:
188
188
  …
189
- If the current adjusts a prior ExplanationOfBenefit, .related.reference = the prior ExplanationOfBenefit identifier and related.relationship value = 'prior'.",SHALL,Health Plan,,true
189
+ If the current adjusts a prior ExplanationOfBenefit, .related.reference = the prior ExplanationOfBenefit identifier and related.relationship value = 'prior'.",SHALL,Health Plan,,true,,
190
190
  hl7.fhir.us.carin-bb_2.0.0,119,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".related:
191
191
  …
192
- If the current ExplanationOfBenefit has been adjusted; related.reference = the ExplanationOfBenefit.identifier of the adjusting ExplanationOfBenefit and related.relationship value = 'replacedby'.",SHALL,Health Plan,,true
192
+ If the current ExplanationOfBenefit has been adjusted; related.reference = the ExplanationOfBenefit.identifier of the adjusting ExplanationOfBenefit and related.relationship value = 'replacedby'.",SHALL,Health Plan,,true,,
193
193
  hl7.fhir.us.carin-bb_2.0.0,120,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".related:
194
194
  …
195
- The .related.reference contains the identifier of the immediately preceding or following ExplanationOfBenefit, not the first or last.",SHALL,Health Plan,,false
196
- hl7.fhir.us.carin-bb_2.0.0,121,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.supportinginfo.sequence rule: client app implementations should look-up supportingInfo elements based on category values instead of sequence values,SHOULD,Consumer,,false
195
+ The .related.reference contains the identifier of the immediately preceding or following ExplanationOfBenefit, not the first or last.",SHALL,Health Plan,,false,,
196
+ hl7.fhir.us.carin-bb_2.0.0,121,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,.supportinginfo.sequence rule: client app implementations should look-up supportingInfo elements based on category values instead of sequence values,SHOULD,Consumer,,false,,
197
197
  hl7.fhir.us.carin-bb_2.0.0,122,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".careTeam.sequence rule:
198
198
  …
199
- Client app implementations SHOULD NOT assign any significance to the sequence values.",SHOULD NOT,Consumer,,false
199
+ Client app implementations SHOULD NOT assign any significance to the sequence values.",SHOULD NOT,Consumer,,false,,
200
200
  hl7.fhir.us.carin-bb_2.0.0,123,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".insurance:
201
201
  …
202
- ExplanationOfBenefit.insurer MAY have a boolean value = 'True'",MAY,Health Plan,,false
202
+ ExplanationOfBenefit.insurer MAY have a boolean value = 'True'",MAY,Health Plan,,false,,
203
203
  hl7.fhir.us.carin-bb_2.0.0,124,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".insurance:
204
204
  …
205
- .insurance occurring other than ExplanationOfBenefit.insurer SHALL NOT have a boolean value = 'True'",SHALL NOT,Health Plan,,false
205
+ .insurance occurring other than ExplanationOfBenefit.insurer SHALL NOT have a boolean value = 'True'",SHALL NOT,Health Plan,,false,,
206
206
  hl7.fhir.us.carin-bb_2.0.0,125,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".insurance.focal:
207
207
  …
208
- If there is an occurrence, with focal = true, EOB.insurance.coverage.payor = EOB.insurer",SHALL,Health Plan,,true
208
+ If there is an occurrence, with focal = true, EOB.insurance.coverage.payor = EOB.insurer",SHALL,Health Plan,,true,,
209
209
  hl7.fhir.us.carin-bb_2.0.0,126,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".insurance.focal:
210
210
  …
211
- There can be 0 or * occurrences with focal = false",MAY,Health Plan,,false
211
+ There can be 0 or * occurrences with focal = false",MAY,Health Plan,,false,,
212
212
  hl7.fhir.us.carin-bb_2.0.0,127,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".insurance.coverage:
213
213
  …
214
- When focal = true, Coverage.payer--> Organization.identifier.",SHALL,Health Plan,,true
214
+ When focal = true, Coverage.payer--> Organization.identifier.",SHALL,Health Plan,,true,,
215
215
  hl7.fhir.us.carin-bb_2.0.0,128,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,".insurance.coverage:
216
216
  …
217
- When focal = false, EOB.insurance.coverage.display = [name of other carrier]",SHALL,Health Plan,,true
218
- hl7.fhir.us.carin-bb_2.0.0,129,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,insurance.coverage: Same as insurance.coverage.organization.,SHALL,Health Plan,,false
217
+ When focal = false, EOB.insurance.coverage.display = [name of other carrier]",SHALL,Health Plan,,true,,
218
+ hl7.fhir.us.carin-bb_2.0.0,129,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit.html#notes-on-fields,insurance.coverage: Same as insurance.coverage.organization.,SHALL,Health Plan,,false,,
219
219
  hl7.fhir.us.carin-bb_2.0.0,130,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,"CPCDS data elements
220
220
  …
221
- If a Payer does not have line item amounts, provide the claim amounts and amount types in the EOB header data elements.",SHALL,Health Plan,,true
221
+ If a Payer does not have line item amounts, provide the claim amounts and amount types in the EOB header data elements.",SHALL,Health Plan,,true,,
222
222
  hl7.fhir.us.carin-bb_2.0.0,131,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,"CPCDS data elements
223
223
  …
224
- Total amounts and amount types of the claim are to be provided in EOB.total.",SHALL,Health Plan,,false
224
+ Total amounts and amount types of the claim are to be provided in EOB.total.",SHALL,Health Plan,,false,,
225
225
  hl7.fhir.us.carin-bb_2.0.0,132,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,"CPCDS data elements
226
226
  …
227
- The in network or out of network payment status of the claim are to be provided in EOB.supportingInfo.",SHALL,Health Plan,,false
227
+ The in network or out of network payment status of the claim are to be provided in EOB.supportingInfo.",SHALL,Health Plan,,false,,
228
228
  hl7.fhir.us.carin-bb_2.0.0,133,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,"A CPT / HCPCS code may not be available
229
229
  …
230
- The cardinality of the HL7 base EOB Resource for item.productOrService is 1..1 if .item is provided.",SHALL,Health Plan,,false
230
+ The cardinality of the HL7 base EOB Resource for item.productOrService is 1..1 if .item is provided.",SHALL,Health Plan,,false,,
231
231
  hl7.fhir.us.carin-bb_2.0.0,134,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,"A CPT / HCPCS code may not be available
232
232
  …
233
- item.productOrService must be populated.",SHALL,Health Plan,,false
233
+ item.productOrService must be populated.",SHALL,Health Plan,,false,,
234
234
  hl7.fhir.us.carin-bb_2.0.0,135,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,"A CPT / HCPCS code may not be available
235
235
  …
236
- it is recommended payers provide a data absent reason when a CPT / HCPCS code is not available.",SHOULD,Health Plan,,false
237
- hl7.fhir.us.carin-bb_2.0.0,136,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,.diagnosis: ICD-10 / ICD-9 diagnosis codes are defined as CodeableConcepts,SHALL,Health Plan,,false
236
+ it is recommended payers provide a data absent reason when a CPT / HCPCS code is not available.",SHOULD,Health Plan,,false,,
237
+ hl7.fhir.us.carin-bb_2.0.0,136,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,.diagnosis: ICD-10 / ICD-9 diagnosis codes are defined as CodeableConcepts,SHALL,Health Plan,,false,,
238
238
  hl7.fhir.us.carin-bb_2.0.0,137,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,".diagnosis.sequence rule:
239
239
  …
240
- Client app implementations should not assign any significance to the sequence values.",SHOULD NOT,Consumer,,false
240
+ Client app implementations should not assign any significance to the sequence values.",SHOULD NOT,Consumer,,false,,
241
241
  hl7.fhir.us.carin-bb_2.0.0,138,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,".diagnosis.sequence rule:
242
242
  …
243
- Client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.",SHOULD,Consumer,,false
243
+ Client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.",SHOULD,Consumer,,false,,
244
244
  hl7.fhir.us.carin-bb_2.0.0,139,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,".procedure.sequence rule:
245
245
  …
246
- Client app implementations should not assign any significance to the sequence values.",SHOULD NOT,Consumer,,false
246
+ Client app implementations should not assign any significance to the sequence values.",SHOULD NOT,Consumer,,false,,
247
247
  hl7.fhir.us.carin-bb_2.0.0,140,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,".procedure.sequence rule:
248
248
  …
249
- Client app implementations should use the values of procedure.type to identify primary and secondary procedures",SHOULD,Consumer,,false
250
- hl7.fhir.us.carin-bb_2.0.0,141,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,".supportingInfo[DRG]: DRGs require the DRG system; i.e., MS-DRG / AP-DRG / APR-DRG, the DRG version and the code value",SHALL,Health Plan,,false
251
- hl7.fhir.us.carin-bb_2.0.0,142,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,.adjudication.amount (populate only if item.adjudication is not available):,SHALL NOT,Health Plan,,true
252
- hl7.fhir.us.carin-bb_2.0.0,143,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,.total.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false
249
+ Client app implementations should use the values of procedure.type to identify primary and secondary procedures",SHOULD,Consumer,,false,,
250
+ hl7.fhir.us.carin-bb_2.0.0,141,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,".supportingInfo[DRG]: DRGs require the DRG system; i.e., MS-DRG / AP-DRG / APR-DRG, the DRG version and the code value",SHALL,Health Plan,,false,,
251
+ hl7.fhir.us.carin-bb_2.0.0,142,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,.adjudication.amount (populate only if item.adjudication is not available):,SHALL NOT,Health Plan,,true,,
252
+ hl7.fhir.us.carin-bb_2.0.0,143,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,.total.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false,,
253
253
  hl7.fhir.us.carin-bb_2.0.0,144,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,"CPCDS data elements
254
254
  …
255
- Line item amounts, amount types and the in network or out of network payment status of the line are to be provided in EOB.item.",SHALL,Health Plan,,false
255
+ Line item amounts, amount types and the in network or out of network payment status of the line are to be provided in EOB.item.",SHALL,Health Plan,,false,,
256
256
  hl7.fhir.us.carin-bb_2.0.0,145,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,"CPCDS data elements
257
257
  …
258
- Total amounts, amount types and the in network or out of network payment status of the claim are to be provided in EOB.total",SHALL,Health Plan,,false
258
+ Total amounts, amount types and the in network or out of network payment status of the claim are to be provided in EOB.total",SHALL,Health Plan,,false,,
259
259
  hl7.fhir.us.carin-bb_2.0.0,146,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,"CPCDS data elements
260
260
  …
261
- If there is a mix of lines paid in network and out of network on a claim, the value of C4BB Payer Benefit Payment Status is ‘Other’",SHALL,Health Plan,,true
262
- hl7.fhir.us.carin-bb_2.0.0,147,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,".diagnosis.sequence rule: diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. Client app implementations should not assign any significance to the sequence values. Client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.",SHOULD NOT,Consumer,,false
263
- hl7.fhir.us.carin-bb_2.0.0,148,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,".supportingInfo[servicefacility]: Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rendering Provider.",SHALL,Health Plan,,false
264
- hl7.fhir.us.carin-bb_2.0.0,149,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,.item. diagnosisSequence: References the sequence number of the associated diagnosis entered above,SHALL,Health Plan,,false
265
- hl7.fhir.us.carin-bb_2.0.0,150,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,.item.productOrService: CPT / HCPCS procedure codes are defined as CodeableConcepts: A revenue code will not be available on an oral claim,SHALL NOT,Health Plan,,false
266
- hl7.fhir.us.carin-bb_2.0.0,151,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,The line item primary body site (tooth or oral cavity) SHALL be specified in the .item.bodySite.,SHALL,Health Plan,,false
267
- hl7.fhir.us.carin-bb_2.0.0,152,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,Additional body sites (tooth or oral cavity) SHALL be specified in supportingInfo[additionalbodysite] repetitions with supportingInfo[additionalbodysite].sequence matching the line items .item.informationSequence,SHALL,Health Plan,,false
268
- hl7.fhir.us.carin-bb_2.0.0,153,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,All Oral line item subsites (.item.subSite repetitions) apply to all the line item's associated tooth surfaces (item.bodySite and .supportingInfo[additionalbodysite] associated with the line item by referencing supportingInfo[additionalbodysite].sequence through .item.informationSequence),SHALL,Health Plan,,false
269
- hl7.fhir.us.carin-bb_2.0.0,154,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,.item.adjudication.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false
270
- hl7.fhir.us.carin-bb_2.0.0,155,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,.total.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false
271
- hl7.fhir.us.carin-bb_2.0.0,156,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,"CPCDS data elements are mapped to EOB header or EOB.item data elements in alignment with claims submission standards. ... If a Payer does not have line item amounts, provide the claim amounts and amount types in the EOB header data elements.",SHALL,Health Plan,,false
272
- hl7.fhir.us.carin-bb_2.0.0,157,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,.item.productOrService: CPT / HCPCS procedure codes are defined as CodeableConcepts,SHALL,Health Plan,,false
261
+ If there is a mix of lines paid in network and out of network on a claim, the value of C4BB Payer Benefit Payment Status is ‘Other’",SHALL,Health Plan,,true,,
262
+ hl7.fhir.us.carin-bb_2.0.0,147,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,".diagnosis.sequence rule: diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. Client app implementations should not assign any significance to the sequence values. Client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.",SHOULD NOT,Consumer,,false,,
263
+ hl7.fhir.us.carin-bb_2.0.0,148,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,".supportingInfo[servicefacility]: Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rendering Provider.",SHALL,Health Plan,,false,,
264
+ hl7.fhir.us.carin-bb_2.0.0,149,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,.item. diagnosisSequence: References the sequence number of the associated diagnosis entered above,SHALL,Health Plan,,false,,
265
+ hl7.fhir.us.carin-bb_2.0.0,150,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,.item.productOrService: CPT / HCPCS procedure codes are defined as CodeableConcepts: A revenue code will not be available on an oral claim,SHALL NOT,Health Plan,,false,,
266
+ hl7.fhir.us.carin-bb_2.0.0,151,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,The line item primary body site (tooth or oral cavity) SHALL be specified in the .item.bodySite.,SHALL,Health Plan,,false,,
267
+ hl7.fhir.us.carin-bb_2.0.0,152,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,Additional body sites (tooth or oral cavity) SHALL be specified in supportingInfo[additionalbodysite] repetitions with supportingInfo[additionalbodysite].sequence matching the line items .item.informationSequence,SHALL,Health Plan,,false,,
268
+ hl7.fhir.us.carin-bb_2.0.0,153,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,All Oral line item subsites (.item.subSite repetitions) apply to all the line item's associated tooth surfaces (item.bodySite and .supportingInfo[additionalbodysite] associated with the line item by referencing supportingInfo[additionalbodysite].sequence through .item.informationSequence),SHALL,Health Plan,,false,,
269
+ hl7.fhir.us.carin-bb_2.0.0,154,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,.item.adjudication.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false,,
270
+ hl7.fhir.us.carin-bb_2.0.0,155,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,.total.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false,,
271
+ hl7.fhir.us.carin-bb_2.0.0,156,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,"CPCDS data elements are mapped to EOB header or EOB.item data elements in alignment with claims submission standards. ... If a Payer does not have line item amounts, provide the claim amounts and amount types in the EOB header data elements.",SHALL,Health Plan,,false,,
272
+ hl7.fhir.us.carin-bb_2.0.0,157,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,.item.productOrService: CPT / HCPCS procedure codes are defined as CodeableConcepts,SHALL,Health Plan,,false,,
273
273
  hl7.fhir.us.carin-bb_2.0.0,158,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,"A CPT / HCPCS or HIPPS code may not be available on an outpatient institutional claim.
274
274
  …
275
- The cardinality of the HL7 base EOB Resource for item.productOrService is 1..1 if .item is provided.",SHALL,Health Plan,,false
275
+ The cardinality of the HL7 base EOB Resource for item.productOrService is 1..1 if .item is provided.",SHALL,Health Plan,,false,,
276
276
  hl7.fhir.us.carin-bb_2.0.0,159,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,"A CPT / HCPCS or HIPPS code may not be available on an outpatient institutional claim.
277
277
  …
278
- item.productOrService must be populated.",SHALL,Health Plan,,false
278
+ item.productOrService must be populated.",SHALL,Health Plan,,false,,
279
279
  hl7.fhir.us.carin-bb_2.0.0,160,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,"A CPT / HCPCS or HIPPS code may not be available on an outpatient institutional claim.
280
280
  …
281
- it is recommended payers provide a data absent reason when a CPT / HCPCS or HIPPS code is not available.",SHOULD,Health Plan,,false
281
+ it is recommended payers provide a data absent reason when a CPT / HCPCS or HIPPS code is not available.",SHOULD,Health Plan,,false,,
282
282
  hl7.fhir.us.carin-bb_2.0.0,161,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy.html,"ExplanationOfBenefit.item.productOrService:
283
283
  …
284
- values are NDC Codes when Compound Code (MapID 78) = 0 or 1.",SHALL,Health Plan,,true
284
+ values are NDC Codes when Compound Code (MapID 78) = 0 or 1.",SHALL,Health Plan,,true,,
285
285
  hl7.fhir.us.carin-bb_2.0.0,162,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy.html,"ExplanationOfBenefit.item.productOrService:
286
286
  …
287
- When the Compound Code = 2, productOrService = ""compound"" and map the ingredient to ExplanationOfBenefit.item.detail.productOrService",SHALL,Health Plan,,true
288
- hl7.fhir.us.carin-bb_2.0.0,163,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy.html,ExplanationOfBenefit.item.productOrService and item.detail.productOrService: Payers shall provide an 11-digit NDC.,SHALL,Health Plan,,false
287
+ When the Compound Code = 2, productOrService = ""compound"" and map the ingredient to ExplanationOfBenefit.item.detail.productOrService",SHALL,Health Plan,,true,,
288
+ hl7.fhir.us.carin-bb_2.0.0,163,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy.html,ExplanationOfBenefit.item.productOrService and item.detail.productOrService: Payers shall provide an 11-digit NDC.,SHALL,Health Plan,,false,,
289
289
  hl7.fhir.us.carin-bb_2.0.0,164,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy.html,"ExplanationOfBenefit.item.quantity:
290
290
  …
291
- populate for all Compound Code values.",SHALL,Health Plan,,false
291
+ populate for all Compound Code values.",SHALL,Health Plan,,false,,
292
292
  hl7.fhir.us.carin-bb_2.0.0,165,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Pharmacy.html,"ExplanationOfBenefit.item.quantity:
293
293
  …
294
- When the Compound Code = 2, if available, map the ingredient to ExplanationOfBenefit.item.detail.quantity",SHALL,Health Plan,,true
295
- hl7.fhir.us.carin-bb_2.0.0,166,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,.diagnosis.sequence rule: diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. Client app implementations should not assign any significance to the sequence values.,SHOULD NOT,Consumer,,false
296
- hl7.fhir.us.carin-bb_2.0.0,167,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,".diagnosis.sequence rule: diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. ...Client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.",SHOULD,Consumer,,false
297
- hl7.fhir.us.carin-bb_2.0.0,168,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,.diagnosis.sequence: sequentially numbers all diagnoses at the header-level. Item-level are referenced from an item using this sequence number,SHALL,Health Plan,,false
298
- hl7.fhir.us.carin-bb_2.0.0,169,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,".supportingInfo[servicefacility]: Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rendering Provider.",SHOULD,Health Plan,,true
299
- hl7.fhir.us.carin-bb_2.0.0,170,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,.item.diagnosisSequence: References the sequence number of the associated diagnosis entered above,SHALL,Health Plan,,false
294
+ When the Compound Code = 2, if available, map the ingredient to ExplanationOfBenefit.item.detail.quantity",SHALL,Health Plan,,true,,
295
+ hl7.fhir.us.carin-bb_2.0.0,166,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,.diagnosis.sequence rule: diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. Client app implementations should not assign any significance to the sequence values.,SHOULD NOT,Consumer,,false,,
296
+ hl7.fhir.us.carin-bb_2.0.0,167,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,".diagnosis.sequence rule: diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. ...Client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.",SHOULD,Consumer,,false,,
297
+ hl7.fhir.us.carin-bb_2.0.0,168,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,.diagnosis.sequence: sequentially numbers all diagnoses at the header-level. Item-level are referenced from an item using this sequence number,SHALL,Health Plan,,false,,
298
+ hl7.fhir.us.carin-bb_2.0.0,169,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,".supportingInfo[servicefacility]: Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Rendering Provider.",SHOULD,Health Plan,,true,,
299
+ hl7.fhir.us.carin-bb_2.0.0,170,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,.item.diagnosisSequence: References the sequence number of the associated diagnosis entered above,SHALL,Health Plan,,false,,
300
300
  hl7.fhir.us.carin-bb_2.0.0,171,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,".item.productOrService: CPT / HCPCS procedure codes are defined as CodeableConcepts: A revenue code will not be available on a professional / non-clinician claim .
301
301
  …
302
- it is recommended payers provide a data absent reason for item.revenue.",SHOULD,Health Plan,,false
302
+ it is recommended payers provide a data absent reason for item.revenue.",SHOULD,Health Plan,,false,,
303
303
  hl7.fhir.us.carin-bb_2.0.0,172,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,"A CPT / HCPCS code may not be available
304
304
  …
305
- it is recommended payers provide a data absent reason when a CPT / HCPCS or code is not available.",SHOULD,Health Plan,,false
306
- hl7.fhir.us.carin-bb_2.0.0,173,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,Every supportingInfo repetitions with a Transportation Services Category code need to be associated with at least one line item by referencing supportingInfo.sequence through .item.informationSequence.,SHALL,Health Plan,,false
307
- hl7.fhir.us.carin-bb_2.0.0,174,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,item.adjudication[benefitpaymentstatus]: in network or out of network payment status for the line,SHALL,Health Plan,,false
308
- hl7.fhir.us.carin-bb_2.0.0,175,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Coverage.html#notes-on-fields,The Coverage Reference Resource shall be returned with data that was effective as of the date of service of the claim,SHALL,Health Plan,,false
309
- hl7.fhir.us.carin-bb_2.0.0,176,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Organization.html,Payers may decide to provide either the data that was in effect as of the date of service or the current data.,MAY,Health Plan,,false
310
- hl7.fhir.us.carin-bb_2.0.0,177,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Organization.html,.identifier[NPI]: Value is conditional depending on the Referring Resource. Populate Service Facility NPI with the value 'NPI has not been assigned' if an NPI has not been assigned to the Service Location Organization,SHALL,Health Plan,,true
311
- hl7.fhir.us.carin-bb_2.0.0,178,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Organization.html,".address: Enter address of the location where the services were rendered. If the location is a component of the Billing Provider, do not populate this data element",SHALL NOT,Health Plan,,true
312
- hl7.fhir.us.carin-bb_2.0.0,179,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Organization.html,".meta.lastUpdated: Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last.",SHALL,Health Plan,,false
313
- hl7.fhir.us.carin-bb_2.0.0,180,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Organization.html,.meta.lastUpdated: ... Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.,SHALL,Consumer,,false
314
- hl7.fhir.us.carin-bb_2.0.0,181,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Patient.html#notes-on-fields,The Member Id is the identifier payers assign to a beneficiary for a contract; it may be different for various lines of business; ie. QHP vs MA. The Unique Member Id is a mastered identifier across all lines of business.,SHALL,Health Plan,,false
315
- hl7.fhir.us.carin-bb_2.0.0,182,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Patient.html#notes-on-fields,Payers may decide to provide either the data that was in effect as of the date of service or the current data.,MAY,Health Plan,,false
316
- hl7.fhir.us.carin-bb_2.0.0,183,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Patient.html#notes-on-fields,".meta.lastUpdated: Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last.",SHALL,Health Plan,,false
317
- hl7.fhir.us.carin-bb_2.0.0,184,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Patient.html#notes-on-fields,.meta.lastUpdated: ... Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.,SHALL,Consumer,,false
318
- hl7.fhir.us.carin-bb_2.0.0,185,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Practitioner.html#notes-on-fields,Payers may decide to provide either the data that was in effect as of the date of service or the current data.,MAY,Health Plan,,false
319
- hl7.fhir.us.carin-bb_2.0.0,186,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Practitioner.html#notes-on-fields,".identifier[NPI], .identifier[tax]: One of these identifiers must be provided",SHALL,Health Plan,,false
320
- hl7.fhir.us.carin-bb_2.0.0,187,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Practitioner.html#notes-on-fields,".meta.lastUpdated: Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last.",SHALL,Health Plan,,false
321
- hl7.fhir.us.carin-bb_2.0.0,188,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Practitioner.html#notes-on-fields,.meta.lastUpdated: … Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.,SHALL,Consumer,,false
322
- hl7.fhir.us.carin-bb_2.0.0,189,https://hl7.org/fhir/us/carin-bb/STU2/,COMPUTABLE REQUIREMENTS TBD,,Health Plan,,
323
- hl7.fhir.us.carin-bb_2.0.0,190,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,.adjudication.amount...: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false
324
- hl7.fhir.us.carin-bb_2.0.0,191,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,.item.adjudication.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false
325
- hl7.fhir.us.carin-bb_2.0.0,192,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,.total.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false
326
- hl7.fhir.us.carin-bb_2.0.0,193,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,.adjudication.amount...: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false
327
- hl7.fhir.us.carin-bb_2.0.0,194,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,.item.adjudication.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false
328
- hl7.fhir.us.carin-bb_2.0.0,195,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,.adjudication.amount...: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false
329
- hl7.fhir.us.carin-bb_2.0.0,196,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,.item.adjudication.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false
330
- hl7.fhir.us.carin-bb_2.0.0,197,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,.adjudication.amount (populate only if item.adjudication is not available):,SHALL NOT,Health Plan,,true
305
+ it is recommended payers provide a data absent reason when a CPT / HCPCS or code is not available.",SHOULD,Health Plan,,false,,
306
+ hl7.fhir.us.carin-bb_2.0.0,173,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,Every supportingInfo repetitions with a Transportation Services Category code need to be associated with at least one line item by referencing supportingInfo.sequence through .item.informationSequence.,SHALL,Health Plan,,false,,
307
+ hl7.fhir.us.carin-bb_2.0.0,174,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,item.adjudication[benefitpaymentstatus]: in network or out of network payment status for the line,SHALL,Health Plan,,false,,
308
+ hl7.fhir.us.carin-bb_2.0.0,175,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Coverage.html#notes-on-fields,The Coverage Reference Resource shall be returned with data that was effective as of the date of service of the claim,SHALL,Health Plan,,false,,
309
+ hl7.fhir.us.carin-bb_2.0.0,176,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Organization.html,Payers may decide to provide either the data that was in effect as of the date of service or the current data.,MAY,Health Plan,,false,,
310
+ hl7.fhir.us.carin-bb_2.0.0,177,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Organization.html,.identifier[NPI]: Value is conditional depending on the Referring Resource. Populate Service Facility NPI with the value 'NPI has not been assigned' if an NPI has not been assigned to the Service Location Organization,SHALL,Health Plan,,true,,
311
+ hl7.fhir.us.carin-bb_2.0.0,178,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Organization.html,".address: Enter address of the location where the services were rendered. If the location is a component of the Billing Provider, do not populate this data element",SHALL NOT,Health Plan,,true,,
312
+ hl7.fhir.us.carin-bb_2.0.0,179,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Organization.html,".meta.lastUpdated: Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last.",SHALL,Health Plan,,false,,
313
+ hl7.fhir.us.carin-bb_2.0.0,180,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Organization.html,.meta.lastUpdated: ... Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.,SHALL,Consumer,,false,,
314
+ hl7.fhir.us.carin-bb_2.0.0,181,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Patient.html#notes-on-fields,The Member Id is the identifier payers assign to a beneficiary for a contract; it may be different for various lines of business; ie. QHP vs MA. The Unique Member Id is a mastered identifier across all lines of business.,SHALL,Health Plan,,false,,
315
+ hl7.fhir.us.carin-bb_2.0.0,182,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Patient.html#notes-on-fields,Payers may decide to provide either the data that was in effect as of the date of service or the current data.,MAY,Health Plan,,false,,
316
+ hl7.fhir.us.carin-bb_2.0.0,183,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Patient.html#notes-on-fields,".meta.lastUpdated: Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last.",SHALL,Health Plan,,false,,
317
+ hl7.fhir.us.carin-bb_2.0.0,184,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Patient.html#notes-on-fields,.meta.lastUpdated: ... Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.,SHALL,Consumer,,false,,
318
+ hl7.fhir.us.carin-bb_2.0.0,185,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Practitioner.html#notes-on-fields,Payers may decide to provide either the data that was in effect as of the date of service or the current data.,MAY,Health Plan,,false,,
319
+ hl7.fhir.us.carin-bb_2.0.0,186,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Practitioner.html#notes-on-fields,".identifier[NPI], .identifier[tax]: One of these identifiers must be provided",SHALL,Health Plan,,false,,
320
+ hl7.fhir.us.carin-bb_2.0.0,187,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Practitioner.html#notes-on-fields,".meta.lastUpdated: Payers SHALL provide the last time the data was updated or the date of creation in the payer’s system of record, whichever comes last.",SHALL,Health Plan,,false,,
321
+ hl7.fhir.us.carin-bb_2.0.0,188,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Practitioner.html#notes-on-fields,.meta.lastUpdated: … Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.,SHALL,Consumer,,false,,
322
+ hl7.fhir.us.carin-bb_2.0.0,189,https://hl7.org/fhir/us/carin-bb/STU2/,COMPUTABLE REQUIREMENTS,DEPRECATED,Health Plan,,,,
323
+ hl7.fhir.us.carin-bb_2.0.0,190,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,.adjudication.amount...: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false,,
324
+ hl7.fhir.us.carin-bb_2.0.0,191,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,.item.adjudication.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false,,
325
+ hl7.fhir.us.carin-bb_2.0.0,192,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,.total.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false,,
326
+ hl7.fhir.us.carin-bb_2.0.0,193,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,.adjudication.amount...: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false,,
327
+ hl7.fhir.us.carin-bb_2.0.0,194,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,.item.adjudication.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false,,
328
+ hl7.fhir.us.carin-bb_2.0.0,195,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,.adjudication.amount...: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false,,
329
+ hl7.fhir.us.carin-bb_2.0.0,196,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,.item.adjudication.amount: Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient),SHALL,Health Plan,,false,,
330
+ hl7.fhir.us.carin-bb_2.0.0,197,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Outpatient-Institutional.html#notes-on-fields,.adjudication.amount (populate only if item.adjudication is not available):,SHALL NOT,Health Plan,,true,,