carin_for_blue_button_test_kit 0.15.1 → 0.15.3
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.
- checksums.yaml +4 -4
- data/lib/carin_for_blue_button_test_kit/capability_statement/tests/instantiates_test.rb +14 -15
- data/lib/carin_for_blue_button_test_kit/capability_statement/tests/json_support_test.rb +0 -1
- data/lib/carin_for_blue_button_test_kit/client/v2.0.0/c4bb_client_test_suite.rb +14 -0
- data/lib/carin_for_blue_button_test_kit/client/v2.0.0/claim_data_request_tests/client_claims_data_attestation_test.rb +2 -2
- data/lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/insurer_same_test.rb +74 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/outcome_complete_test.rb +32 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/type_data_absent_test.rb +41 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/authentication.rb +30 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/last_updated.rb +31 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/must_support_absent_reason.rb +26 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/must_support_display.rb +26 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/must_support_missing.rb +27 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client.rb +25 -0
- 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
- 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
- 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
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/00_authorization_group.rb +15 -0
- 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
- 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
- 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
- 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
- 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
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/01_must_support_group.rb +19 -0
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/03_eob_group.rb +25 -0
- 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
- 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
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/04_eob_inpatient_group.rb +13 -0
- 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
- 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
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/05_eob_outpatient_group.rb +13 -0
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group.rb +23 -0
- 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
- 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
- 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
- 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
- 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
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/07_eob_pharmacy_group.rb +19 -0
- 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
- 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
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/08_eob_nonclinician_group.rb +13 -0
- 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
- 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
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/09_organization_group.rb +12 -0
- 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
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/10_practitioner_group.rb +10 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/adjudication_amount.rb +38 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/amount_calculations.rb +69 -0
- 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
- 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
- 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
- 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
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/licensing.rb +33 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/meta_lastupdated.rb +46 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group.rb +24 -0
- data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server.rb +37 -0
- data/lib/carin_for_blue_button_test_kit/generated/v1.1.0/c4bb_test_suite.rb +2 -0
- data/lib/carin_for_blue_button_test_kit/generated/v2.0.0/c4bb_test_suite.rb +20 -2
- data/lib/carin_for_blue_button_test_kit/generated/v2.0.0/eob_group.rb +6 -0
- data/lib/carin_for_blue_button_test_kit/generated/v2.0.0-dev-nonfinancial/c4bb_test_suite.rb +8 -0
- data/lib/carin_for_blue_button_test_kit/generator/suite_generator.rb +1 -1
- data/lib/carin_for_blue_button_test_kit/generator/templates/group.rb.erb +7 -1
- data/lib/carin_for_blue_button_test_kit/generator/templates/suite.rb.erb +21 -1
- 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
- data/lib/carin_for_blue_button_test_kit/requirements/generated/c4bb_v110_requirements_coverage.csv +1 -0
- data/lib/carin_for_blue_button_test_kit/requirements/generated/c4bb_v200_client_requirements_coverage.csv +47 -0
- 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
- data/lib/carin_for_blue_button_test_kit/requirements/generated/c4bb_v200devnonfinancial_requirements_coverage.csv +244 -0
- data/lib/carin_for_blue_button_test_kit/requirements/hl7.fhir.us.carin-bb_2.0.0_reqs.xlsx +0 -0
- data/lib/carin_for_blue_button_test_kit/version.rb +2 -2
- data/lib/carin_for_blue_button_test_kit.rb +0 -1
- metadata +80 -15
- data/lib/carin_for_blue_button_test_kit/requirements/carin-for-blue-button-test-kit_out_of_scope_requirements.csv +0 -68
- data/lib/inferno_requirements_tools/ext/inferno_core/runnable.rb +0 -22
- data/lib/inferno_requirements_tools/rake/rakefile_template +0 -31
- data/lib/inferno_requirements_tools/tasks/requirements_coverage.rb +0 -284
- data/lib/requirements_config.yaml +0 -17
@@ -1,278 +1,244 @@
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Req Set,ID,URL,Requirement,Conformance,
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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
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Req Set,ID,URL,Requirement,Conformance,Actors,Conditionality,Not Tested Reason,Not Tested Details,CARIN IG for Blue Button® v2.0.0 Short ID(s),CARIN IG for Blue Button® v2.0.0 Full ID(s)
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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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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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: ...
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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
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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,8.01,c4bb_v200_client-c4bb_client_attestation_test_group-client_claims_data_attestation,NA,NA
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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,,,NA,NA
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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,,,3.2.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_must_support-carin_server_requirement_2_attestation
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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:...
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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
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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,,,NA,NA
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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,,,3.2.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_must_support-carin_server_requirement_5_attestation
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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: ...
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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
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hl7.fhir.us.carin-bb_2.0.0,
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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,NA,NA,,
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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,,,3.2.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_must_support-carin_server_requirement_7_attestation
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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,,,3.2.04,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_must_support-carin_server_requirement_9_attestation
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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,,,3.2.05,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_must_support-carin_server_requirement_10_attestation
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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:…
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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
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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,,,"2.2.05, 2.3.18, 2.3.20, 2.3.22, 2.3.24, 2.3.26, 2.3.28, 2.4.06, 2.5.05, 2.6.05, 2.7.05","c4bb_v200-Group02-c4bb_v200_patient-c4bb_v200_patient_must_support_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_must_support_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_inpatient_institutional_must_support_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_outpatient_institutional_must_support_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_oral_must_support_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_pharmacy_must_support_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_professional_non_clinician_must_support_test, c4bb_v200-Group02-c4bb_v200_coverage-c4bb_v200_coverage_must_support_test, c4bb_v200-Group02-c4bb_v200_organization-c4bb_v200_organization_must_support_test, c4bb_v200-Group02-c4bb_v200_practitioner-c4bb_v200_practitioner_must_support_test, c4bb_v200-Group02-c4bb_v200_related_person-c4bb_v200_related_person_must_support_test"
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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:…
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Conform to the US Core Health Plan Capability Statement expectations for that profile's type.",SHALL,Health Plan
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hl7.fhir.us.carin-bb_2.0.0,
|
32
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
33
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
34
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
35
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
36
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
37
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
38
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
39
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
40
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
41
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
42
|
-
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,Not Tested,Not Tested,Not Tested,Not Tested
|
43
|
-
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,Not Tested,Not Tested,Not Tested,Not Tested
|
44
|
-
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,NA,NA,,
|
19
|
+
Conform to the US Core Health Plan Capability Statement expectations for that profile's type.",SHALL,Health Plan,false,,,"2.2.04, 2.3.17, 2.3.19, 2.3.21, 2.3.23, 2.3.25, 2.3.27, 2.4.05, 2.5.04, 2.6.04, 2.7.04","c4bb_v200-Group02-c4bb_v200_patient-c4bb_v200_patient_validation_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_validation_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_inpatient_institutional_validation_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_outpatient_institutional_validation_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_oral_validation_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_pharmacy_validation_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_professional_non_clinician_validation_test, c4bb_v200-Group02-c4bb_v200_coverage-c4bb_v200_coverage_validation_test, c4bb_v200-Group02-c4bb_v200_organization-c4bb_v200_organization_validation_test, c4bb_v200-Group02-c4bb_v200_practitioner-c4bb_v200_practitioner_validation_test, c4bb_v200-Group02-c4bb_v200_related_person-c4bb_v200_related_person_validation_test"
|
20
|
+
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,,,"",""
|
21
|
+
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,,,2.1.04,c4bb_v200-Group02-capability_statement_group-carin_bb_instantiate
|
22
|
+
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,,,"",""
|
23
|
+
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,,,3.11.06,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-carin_server_requirement_19_attestation
|
24
|
+
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,,,"",""
|
25
|
+
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,,,"",""
|
26
|
+
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,,,"",""
|
27
|
+
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,,,"",""
|
28
|
+
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,,,"",""
|
29
|
+
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,,,"",""
|
30
|
+
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,,,"",""
|
31
|
+
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,,,3.11.07,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-carin_server_requirement_28_attestation
|
32
|
+
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,,,3.11.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-carin_licensing_test
|
33
|
+
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,,,3.11.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-carin_licensing_test
|
34
|
+
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,,,3.1.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_48_57_attestation
|
35
|
+
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,,,3.1.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_48_57_attestation
|
36
|
+
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,,,3.1.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_48_57_attestation
|
37
|
+
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,,,3.1.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_48_57_attestation
|
45
38
|
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.
|
46
39
|
2. At present there is no explicit regulatory requirement for the use of these technologies in conjunction with this guide.
|
47
40
|
3. However, to meet the statutes, regulations, and guiding principles above, consent directives and security labels MAY be considered and used.
|
48
|
-
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
|
49
|
-
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
|
50
|
-
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
|
51
|
-
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
|
52
|
-
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
|
53
|
-
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,
|
54
|
-
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
|
55
|
-
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
|
41
|
+
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,,,"",""
|
42
|
+
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,,,"",""
|
43
|
+
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,,,"",""
|
44
|
+
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,,,3.1.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_48_57_attestation
|
45
|
+
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,,,"",""
|
46
|
+
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,,,3.1.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_48_57_attestation
|
47
|
+
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,,,1.1,c4bb_v200-c4bb_v200_smart_launch-smart_discovery
|
48
|
+
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,,,"",""
|
56
49
|
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)...
|
57
50
|
|
58
|
-
`launch-standalone`: support for SMART’s Standalone Launch mode",SHALL,Health Plan
|
51
|
+
`launch-standalone`: support for SMART’s Standalone Launch mode",SHALL,Health Plan,false,,,"1.2, 3.1.03","c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_60_67_attestation"
|
59
52
|
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)…
|
60
53
|
|
61
|
-
`client-public`: support for SMART’s public Consumer profile (no Consumer authentication)",SHALL,Health Plan
|
54
|
+
`client-public`: support for SMART’s public Consumer profile (no Consumer authentication)",SHALL,Health Plan,false,,,3.1.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_60_67_attestation
|
62
55
|
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”
|
63
56
|
...
|
64
|
-
client-confidential-symmetric: support for SMART’s confidential client profile",SHALL,Health Plan
|
57
|
+
client-confidential-symmetric: support for SMART’s confidential client profile",SHALL,Health Plan,false,,,3.1.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_60_67_attestation
|
65
58
|
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)...
|
66
59
|
|
67
|
-
`sso-openid-connect`: support for SMART’s OpenID Connect profile",SHALL,Health Plan
|
60
|
+
`sso-openid-connect`: support for SMART’s OpenID Connect profile",SHALL,Health Plan,false,,,3.1.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_60_67_attestation
|
68
61
|
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)...
|
69
62
|
|
70
|
-
`context-standalone-patient`: support for patient-level launch context (requested by launch/patient scope, conveyed via patient token parameter)",SHALL,Health Plan
|
63
|
+
`context-standalone-patient`: support for patient-level launch context (requested by launch/patient scope, conveyed via patient token parameter)",SHALL,Health Plan,false,,,3.1.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_60_67_attestation
|
71
64
|
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)…
|
72
65
|
|
73
|
-
`permission-offline`: support for refresh tokens (requested by offline_access scope)",SHALL,Health Plan
|
66
|
+
`permission-offline`: support for refresh tokens (requested by offline_access scope)",SHALL,Health Plan,false,,,3.1.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_60_67_attestation
|
74
67
|
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)…
|
75
68
|
|
76
|
-
`permission-patient`: support for patient-level scopes (e.g. patient Observation.read)",SHALL,Health Plan
|
69
|
+
`permission-patient`: support for patient-level scopes (e.g. patient Observation.read)",SHALL,Health Plan,false,,,3.1.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_60_67_attestation
|
77
70
|
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)…
|
78
71
|
|
79
|
-
`permission-user`: support for user-level scopes (e.g. user/Appointment.read)",SHALL,Health Plan
|
80
|
-
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
|
81
|
-
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
|
82
|
-
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
|
83
|
-
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
|
84
|
-
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
|
85
|
-
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
|
86
|
-
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
|
87
|
-
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
|
88
|
-
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
|
89
|
-
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
|
90
|
-
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
|
91
|
-
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
|
92
|
-
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
|
93
|
-
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
|
94
|
-
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
|
95
|
-
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
|
96
|
-
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
|
97
|
-
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
|
98
|
-
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
|
99
|
-
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
|
100
|
-
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
|
101
|
-
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
|
102
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
103
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
104
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
105
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
106
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
107
|
-
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,NA,NA,"2.2, 2.3, 2.4, 2.5, 2.6, 2.7","c4bb_v200-Group02-c4bb_v200_patient, c4bb_v200-Group02-c4bb_v200_eob, c4bb_v200-Group02-c4bb_v200_coverage, c4bb_v200-Group02-c4bb_v200_organization, c4bb_v200-Group02-c4bb_v200_practitioner, c4bb_v200-Group02-c4bb_v200_related_person"
|
108
|
-
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,NA,NA,Not Tested,Not Tested
|
72
|
+
`permission-user`: support for user-level scopes (e.g. user/Appointment.read)",SHALL,Health Plan,false,,,3.1.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_60_67_attestation
|
73
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
74
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
75
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
76
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
77
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
78
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
79
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
80
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
81
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
82
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
83
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
84
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
85
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
86
|
+
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,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
|
87
|
+
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,,,"",""
|
88
|
+
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,,,"",""
|
89
|
+
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,,,"",""
|
90
|
+
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,,,"",""
|
91
|
+
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,,,"",""
|
92
|
+
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,,,3.11.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-coverage_reference_resource
|
93
|
+
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,,,"",""
|
94
|
+
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,,,3.11.05,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-meta_last_updated
|
95
|
+
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,,,3.11.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-coverage_reference_resource
|
96
|
+
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,,,"",""
|
97
|
+
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,,,3.11.05,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-meta_last_updated
|
98
|
+
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,,,"2.2, 2.3, 2.4, 2.5, 2.6, 2.7","c4bb_v200-Group02-c4bb_v200_patient, c4bb_v200-Group02-c4bb_v200_eob, c4bb_v200-Group02-c4bb_v200_coverage, c4bb_v200-Group02-c4bb_v200_organization, c4bb_v200-Group02-c4bb_v200_practitioner, c4bb_v200-Group02-c4bb_v200_related_person"
|
99
|
+
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,NA,NA
|
109
100
|
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:
|
110
101
|
- (Status 400): invalid parameter
|
111
102
|
- (Status 401/4xx): unauthorized request
|
112
103
|
- (Status 403): insufficient scope
|
113
104
|
- (Status 404): unknown resource
|
114
|
-
- (Status 410): deleted resource.",SHALL,Health Plan
|
115
|
-
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
|
116
|
-
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
|
117
|
-
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
|
118
|
-
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
|
119
|
-
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
|
120
|
-
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
|
121
|
-
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
|
122
|
-
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
|
123
|
-
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
|
124
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
125
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
126
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
127
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
128
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
129
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
130
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
131
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
132
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
133
|
-
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,NA,NA,,
|
134
|
-
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,NA,NA,,
|
105
|
+
- (Status 410): deleted resource.",SHALL,Health Plan,false,,,3.1.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_97_attestation
|
106
|
+
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,,,2.1.03,c4bb_v200-Group02-capability_statement_group-carin_bb_json_support
|
107
|
+
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,,,3.11.08,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-carin_server_requirement_99_attestation
|
108
|
+
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,,,"2.2.01, 2.2.02, 2.3.01, 2.3.02, 2.3.03, 2.3.04, 2.3.05, 2.3.06, 2.3.07, 2.3.08, 2.4.01, 2.4.02, 2.5.01, 2.5.02, 2.6.01, 2.6.02, 2.7.01, 2.7.02","c4bb_v200-Group02-c4bb_v200_patient-c4bb_v200_patient__id_search_test, c4bb_v200-Group02-c4bb_v200_patient-c4bb_v200_patient__lastUpdated_search_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_patient_search_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob__id_search_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob__lastUpdated_search_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_type_search_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_identifier_search_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_service_date_search_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_service_start_date_search_test, c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_billable_period_start_search_test, c4bb_v200-Group02-c4bb_v200_coverage-c4bb_v200_coverage__id_search_test, c4bb_v200-Group02-c4bb_v200_coverage-c4bb_v200_coverage__lastUpdated_search_test, c4bb_v200-Group02-c4bb_v200_organization-c4bb_v200_organization__id_search_test, c4bb_v200-Group02-c4bb_v200_organization-c4bb_v200_organization__lastUpdated_search_test, c4bb_v200-Group02-c4bb_v200_practitioner-c4bb_v200_practitioner__id_search_test, c4bb_v200-Group02-c4bb_v200_practitioner-c4bb_v200_practitioner__lastUpdated_search_test, c4bb_v200-Group02-c4bb_v200_related_person-c4bb_v200_related_person__id_search_test, c4bb_v200-Group02-c4bb_v200_related_person-c4bb_v200_related_person__lastUpdated_search_test"
|
109
|
+
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,,,"",""
|
110
|
+
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,,,3.1.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_security-carin_server_requirement_97_attestation
|
111
|
+
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,,,2.3,c4bb_v200-Group02-c4bb_v200_eob
|
112
|
+
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,,,"",""
|
113
|
+
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,,,3.3.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_105_attestation
|
114
|
+
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,,,"",""
|
115
|
+
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,,,3.3.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_108_attestation
|
116
|
+
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,,,"",""
|
117
|
+
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,,,"",""
|
118
|
+
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,,,2.3.17,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_validation_test
|
119
|
+
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,,,"",""
|
120
|
+
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,,,2.3.17,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_validation_test
|
121
|
+
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,,,"2.3.29, 3.3.03","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_type_data_absent, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_115_attestation"
|
122
|
+
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,,,"2.3.30, 3.3.04","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_116_117_attestation"
|
123
|
+
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,,,"2.3.31, 3.3.04","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_outcome_complete, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_116_117_attestation"
|
135
124
|
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:
|
136
125
|
…
|
137
|
-
If the current adjusts a prior ExplanationOfBenefit, .related.reference = the prior ExplanationOfBenefit identifier and related.relationship value = 'prior'.",SHALL,Health Plan
|
126
|
+
If the current adjusts a prior ExplanationOfBenefit, .related.reference = the prior ExplanationOfBenefit identifier and related.relationship value = 'prior'.",SHALL,Health Plan,true,,,3.3.05,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_118_attestation
|
138
127
|
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:
|
139
128
|
…
|
140
|
-
If the current ExplanationOfBenefit has been adjusted; related.reference = the ExplanationOfBenefit.identifier of the adjusting ExplanationOfBenefit and related.relationship value = 'replacedby'.",SHALL,Health Plan
|
129
|
+
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,,,3.3.06,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_119_attestation
|
141
130
|
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:
|
142
131
|
…
|
143
|
-
The .related.reference contains the identifier of the immediately preceding or following ExplanationOfBenefit, not the first or last.",SHALL,Health Plan
|
144
|
-
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,Not Tested,Not Tested,NA,NA
|
145
|
-
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:
|
146
|
-
…
|
147
|
-
Client app implementations SHOULD NOT assign any significance to the sequence values.",SHOULD NOT,Consumer,,false,Not Tested,Not Tested,NA,NA
|
132
|
+
The .related.reference contains the identifier of the immediately preceding or following ExplanationOfBenefit, not the first or last.",SHALL,Health Plan,false,,,3.3.07,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_120_attestation
|
148
133
|
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:
|
149
134
|
…
|
150
|
-
ExplanationOfBenefit.insurer MAY have a boolean value = 'True'",MAY,Health Plan
|
135
|
+
ExplanationOfBenefit.insurer MAY have a boolean value = 'True'",MAY,Health Plan,false,,,"",""
|
151
136
|
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:
|
152
137
|
…
|
153
|
-
.insurance occurring other than ExplanationOfBenefit.insurer SHALL NOT have a boolean value = 'True'",SHALL NOT,Health Plan
|
138
|
+
.insurance occurring other than ExplanationOfBenefit.insurer SHALL NOT have a boolean value = 'True'",SHALL NOT,Health Plan,false,,,"2.3.30, 3.3.08","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation"
|
154
139
|
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:
|
155
140
|
…
|
156
|
-
If there is an occurrence, with focal = true, EOB.insurance.coverage.payor = EOB.insurer",SHALL,Health Plan
|
141
|
+
If there is an occurrence, with focal = true, EOB.insurance.coverage.payor = EOB.insurer",SHALL,Health Plan,true,,,"2.3.30, 3.3.08","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation"
|
157
142
|
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:
|
158
143
|
…
|
159
|
-
There can be 0 or * occurrences with focal = false",MAY,Health Plan
|
144
|
+
There can be 0 or * occurrences with focal = false",MAY,Health Plan,false,,,"",""
|
160
145
|
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:
|
161
146
|
…
|
162
|
-
When focal = true, Coverage.payer--> Organization.identifier.",SHALL,Health Plan
|
147
|
+
When focal = true, Coverage.payer--> Organization.identifier.",SHALL,Health Plan,true,,,"2.3.30, 3.3.08","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation"
|
163
148
|
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:
|
164
149
|
…
|
165
|
-
When focal = false, EOB.insurance.coverage.display = [name of other carrier]",SHALL,Health Plan
|
166
|
-
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
|
150
|
+
When focal = false, EOB.insurance.coverage.display = [name of other carrier]",SHALL,Health Plan,true,,,"2.3.30, 3.3.08","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation"
|
151
|
+
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,,,"2.3.30, 3.3.08","c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_custom_eob_insurer_same, c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob-carin_server_requirement_124_125_127_128_129_attestation"
|
167
152
|
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
|
168
153
|
…
|
169
|
-
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
|
154
|
+
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,,,3.4.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_inpatient-carin_server_requirement_130_attestation
|
170
155
|
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
|
171
156
|
…
|
172
|
-
Total amounts and amount types of the claim are to be provided in EOB.total.",SHALL,Health Plan
|
157
|
+
Total amounts and amount types of the claim are to be provided in EOB.total.",SHALL,Health Plan,false,,,2.3.17,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_validation_test
|
173
158
|
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
|
174
159
|
…
|
175
|
-
The in network or out of network payment status of the claim are to be provided in EOB.supportingInfo.",SHALL,Health Plan
|
160
|
+
The in network or out of network payment status of the claim are to be provided in EOB.supportingInfo.",SHALL,Health Plan,false,,,3.4.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_inpatient-carin_server_requirement_132_attestation
|
176
161
|
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
|
177
162
|
…
|
178
|
-
The cardinality of the HL7 base EOB Resource for item.productOrService is 1..1 if .item is provided.",SHALL,Health Plan
|
163
|
+
The cardinality of the HL7 base EOB Resource for item.productOrService is 1..1 if .item is provided.",SHALL,Health Plan,false,,,2.3.19,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_inpatient_institutional_validation_test
|
179
164
|
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
|
180
165
|
…
|
181
|
-
item.productOrService must be populated.",SHALL,Health Plan
|
166
|
+
item.productOrService must be populated.",SHALL,Health Plan,false,,,2.3.19,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_inpatient_institutional_validation_test
|
182
167
|
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
|
183
168
|
…
|
184
|
-
it is recommended payers provide a data absent reason when a CPT / HCPCS code is not available.",SHOULD,Health Plan
|
185
|
-
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
|
186
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
187
|
-
|
188
|
-
|
189
|
-
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:
|
190
|
-
…
|
191
|
-
Client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.",SHOULD,Consumer,,false,Not Tested,Not Tested,NA,NA
|
192
|
-
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:
|
193
|
-
…
|
194
|
-
Client app implementations should not assign any significance to the sequence values.",SHOULD NOT,Consumer,,false,Not Tested,Not Tested,NA,NA
|
195
|
-
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:
|
196
|
-
…
|
197
|
-
Client app implementations should use the values of procedure.type to identify primary and secondary procedures",SHOULD,Consumer,,false,Not Tested,Not Tested,NA,NA
|
198
|
-
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,NA,NA,2.3.19,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_inpatient_institutional_validation_test
|
199
|
-
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,NA,NA,,
|
200
|
-
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,NA,NA,Not Tested,Not Tested
|
169
|
+
it is recommended payers provide a data absent reason when a CPT / HCPCS code is not available.",SHOULD,Health Plan,false,,,"",""
|
170
|
+
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,,,2.3.19,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_inpatient_institutional_validation_test
|
171
|
+
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,,,2.3.19,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_inpatient_institutional_validation_test
|
172
|
+
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,,,3.11.04,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-adjudication_amount
|
173
|
+
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,,,3.11.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-amount_calculations
|
201
174
|
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
|
202
175
|
…
|
203
|
-
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
|
176
|
+
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,,,3.6.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_oral-carin_server_requirement_144_145_146_attestation
|
204
177
|
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
|
205
178
|
…
|
206
|
-
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
|
179
|
+
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,,,3.6.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_oral-carin_server_requirement_144_145_146_attestation
|
207
180
|
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
|
208
181
|
…
|
209
|
-
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
|
210
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
211
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
212
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
213
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
214
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
215
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
216
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
217
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
218
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
219
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
220
|
-
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,NA,NA,,
|
182
|
+
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,,,3.6.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_oral-carin_server_requirement_144_145_146_attestation
|
183
|
+
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,,,3.6.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_oral-carin_server_requirement_148_attestation
|
184
|
+
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,,,3.6.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_oral-carin_server_requirement_149_attestation
|
185
|
+
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,,,3.6.04,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_oral-carin_server_requirement_150_attestation
|
186
|
+
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,,,3.6.05,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_oral-carin_server_requirement_151_attestation
|
187
|
+
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,,,3.6.06,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_oral-carin_server_requirement_152_attestation
|
188
|
+
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,,,3.6.07,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_oral-carin_server_requirement_153_attestation
|
189
|
+
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,,,3.11.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-amount_calculations
|
190
|
+
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,,,3.11.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-amount_calculations
|
191
|
+
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,,,3.5.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_outpatient-carin_server_requirement_156_attestation
|
192
|
+
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,,,3.5.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_outpatient-carin_server_requirement_157_158_159_attestation
|
221
193
|
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.
|
222
194
|
…
|
223
|
-
The cardinality of the HL7 base EOB Resource for item.productOrService is 1..1 if .item is provided.",SHALL,Health Plan
|
195
|
+
The cardinality of the HL7 base EOB Resource for item.productOrService is 1..1 if .item is provided.",SHALL,Health Plan,false,,,3.5.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_outpatient-carin_server_requirement_157_158_159_attestation
|
224
196
|
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.
|
225
197
|
…
|
226
|
-
item.productOrService must be populated.",SHALL,Health Plan
|
198
|
+
item.productOrService must be populated.",SHALL,Health Plan,false,,,3.5.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_outpatient-carin_server_requirement_157_158_159_attestation
|
227
199
|
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.
|
228
200
|
…
|
229
|
-
it is recommended payers provide a data absent reason when a CPT / HCPCS or HIPPS code is not available.",SHOULD,Health Plan
|
201
|
+
it is recommended payers provide a data absent reason when a CPT / HCPCS or HIPPS code is not available.",SHOULD,Health Plan,false,,,"",""
|
230
202
|
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:
|
231
203
|
…
|
232
|
-
values are NDC Codes when Compound Code (MapID 78) = 0 or 1.",SHALL,Health Plan
|
204
|
+
values are NDC Codes when Compound Code (MapID 78) = 0 or 1.",SHALL,Health Plan,true,,,3.7.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_pharmacy-carin_server_requirement_161_attestation
|
233
205
|
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:
|
234
206
|
…
|
235
|
-
When the Compound Code = 2, productOrService = ""compound"" and map the ingredient to ExplanationOfBenefit.item.detail.productOrService",SHALL,Health Plan
|
236
|
-
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
|
207
|
+
When the Compound Code = 2, productOrService = ""compound"" and map the ingredient to ExplanationOfBenefit.item.detail.productOrService",SHALL,Health Plan,true,,,3.7.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_pharmacy-carin_server_requirement_162_attestation
|
208
|
+
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,,,3.7.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_pharmacy-carin_server_requirement_163_attestation
|
237
209
|
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:
|
238
210
|
…
|
239
|
-
populate for all Compound Code values.",SHALL,Health Plan
|
211
|
+
populate for all Compound Code values.",SHALL,Health Plan,false,,,3.7.04,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_pharmacy-carin_server_requirement_164_attestation
|
240
212
|
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:
|
241
213
|
…
|
242
|
-
When the Compound Code = 2, if available, map the ingredient to ExplanationOfBenefit.item.detail.quantity",SHALL,Health Plan
|
243
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
244
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
245
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
246
|
-
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,NA,NA,Not Tested,Not Tested
|
247
|
-
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,NA,NA,,
|
214
|
+
When the Compound Code = 2, if available, map the ingredient to ExplanationOfBenefit.item.detail.quantity",SHALL,Health Plan,true,,,3.7.05,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_pharmacy-carin_server_requirement_165_attestation
|
215
|
+
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,,,3.8.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_nonclinician-carin_server_requirement_168_170_attestation
|
216
|
+
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,,,"",""
|
217
|
+
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,,,3.8.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_nonclinician-carin_server_requirement_168_170_attestation
|
248
218
|
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 .
|
249
219
|
…
|
250
|
-
it is recommended payers provide a data absent reason for item.revenue.",SHOULD,Health Plan
|
220
|
+
it is recommended payers provide a data absent reason for item.revenue.",SHOULD,Health Plan,false,,,"",""
|
251
221
|
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
|
252
222
|
…
|
253
|
-
it is recommended payers provide a data absent reason when a CPT / HCPCS or code is not available.",SHOULD,Health Plan
|
254
|
-
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
|
255
|
-
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
|
256
|
-
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
|
257
|
-
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
|
258
|
-
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
|
259
|
-
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
|
260
|
-
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
|
261
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
262
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
263
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
264
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
265
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
266
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
267
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
268
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
269
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
270
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
271
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
272
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
273
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
274
|
-
hl7.fhir.us.carin-bb_2.0.0,
|
275
|
-
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,NA,NA,Not Tested,Not Tested
|
276
|
-
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,NA,NA,Not Tested,Not Tested
|
277
|
-
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,NA,NA,Not Tested,Not Tested
|
278
|
-
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,NA,NA,,
|
223
|
+
it is recommended payers provide a data absent reason when a CPT / HCPCS or code is not available.",SHOULD,Health Plan,false,,,"",""
|
224
|
+
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,,,3.8.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_eob_nonclinician-carin_server_requirement_173_attestation
|
225
|
+
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,,,"",""
|
226
|
+
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,,,3.11.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-coverage_reference_resource
|
227
|
+
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,,,"",""
|
228
|
+
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,,,3.9.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_organization-carin_server_requirement_177_attestation
|
229
|
+
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,,,3.9.02,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_organization-carin_server_requirement_178_attestation
|
230
|
+
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,,,3.11.05,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-meta_last_updated
|
231
|
+
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,,,"",""
|
232
|
+
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,,,"",""
|
233
|
+
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,,,3.11.05,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-meta_last_updated
|
234
|
+
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,,,"",""
|
235
|
+
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,,,3.10.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_practitioner-carin_server_requirement_186_attestation
|
236
|
+
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,,,3.11.05,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-meta_last_updated
|
237
|
+
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,,,3.11.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-amount_calculations
|
238
|
+
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,,,3.11.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-amount_calculations
|
239
|
+
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,,,3.11.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-amount_calculations
|
240
|
+
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,,,3.11.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-amount_calculations
|
241
|
+
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,,,3.11.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-amount_calculations
|
242
|
+
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,,,3.11.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-amount_calculations
|
243
|
+
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,,,3.11.03,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-amount_calculations
|
244
|
+
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,,,3.11.04,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_crosscutting-adjudication_amount
|