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.
Files changed (92) hide show
  1. checksums.yaml +4 -4
  2. data/lib/carin_for_blue_button_test_kit/capability_statement/tests/instantiates_test.rb +14 -15
  3. data/lib/carin_for_blue_button_test_kit/capability_statement/tests/json_support_test.rb +0 -1
  4. data/lib/carin_for_blue_button_test_kit/client/v2.0.0/c4bb_client_test_suite.rb +14 -0
  5. data/lib/carin_for_blue_button_test_kit/client/v2.0.0/claim_data_request_tests/client_claims_data_attestation_test.rb +2 -2
  6. data/lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/insurer_same_test.rb +74 -0
  7. data/lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/outcome_complete_test.rb +32 -0
  8. data/lib/carin_for_blue_button_test_kit/custom_groups/v2.0.0/eob/type_data_absent_test.rb +41 -0
  9. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/authentication.rb +30 -0
  10. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/last_updated.rb +31 -0
  11. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/must_support_absent_reason.rb +26 -0
  12. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/must_support_display.rb +26 -0
  13. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client/must_support_missing.rb +27 -0
  14. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_client.rb +25 -0
  15. 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
  16. 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
  17. 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
  18. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/00_authorization_group.rb +15 -0
  19. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/01_must_support_group/attestation_test_requirement_10.rb +26 -0
  20. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/01_must_support_group/attestation_test_requirement_2.rb +29 -0
  21. 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
  22. 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
  23. 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
  24. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/01_must_support_group.rb +19 -0
  25. 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
  26. 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
  27. 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
  28. 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
  29. 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
  30. 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
  31. 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
  32. 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
  33. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/03_eob_group.rb +25 -0
  34. 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
  35. 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
  36. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/04_eob_inpatient_group.rb +13 -0
  37. 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
  38. 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
  39. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/05_eob_outpatient_group.rb +13 -0
  40. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group/attestation_test_requirement_144.rb +33 -0
  41. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group/attestation_test_requirement_148.rb +29 -0
  42. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group/attestation_test_requirement_149.rb +27 -0
  43. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group/attestation_test_requirement_150.rb +29 -0
  44. 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
  45. 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
  46. 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
  47. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/06_eob_oral_group.rb +23 -0
  48. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/07_eob_pharmacy_group/attestation_test_requirement_161.rb +27 -0
  49. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/07_eob_pharmacy_group/attestation_test_requirement_162.rb +27 -0
  50. 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
  51. 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
  52. 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
  53. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/07_eob_pharmacy_group.rb +19 -0
  54. 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
  55. 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
  56. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/08_eob_nonclinician_group.rb +13 -0
  57. 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
  58. 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
  59. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/09_organization_group.rb +12 -0
  60. 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
  61. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/10_practitioner_group.rb +10 -0
  62. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/adjudication_amount.rb +38 -0
  63. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/amount_calculations.rb +69 -0
  64. 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
  65. 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
  66. 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
  67. 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
  68. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/licensing.rb +33 -0
  69. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group/meta_lastupdated.rb +46 -0
  70. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server/11_crosscutting_group.rb +24 -0
  71. data/lib/carin_for_blue_button_test_kit/custom_groups/visual_inspection_and_attestation/v200_server.rb +37 -0
  72. data/lib/carin_for_blue_button_test_kit/generated/v1.1.0/c4bb_test_suite.rb +2 -0
  73. data/lib/carin_for_blue_button_test_kit/generated/v2.0.0/c4bb_test_suite.rb +20 -2
  74. data/lib/carin_for_blue_button_test_kit/generated/v2.0.0/eob_group.rb +6 -0
  75. data/lib/carin_for_blue_button_test_kit/generated/v2.0.0-dev-nonfinancial/c4bb_test_suite.rb +8 -0
  76. data/lib/carin_for_blue_button_test_kit/generator/suite_generator.rb +1 -1
  77. data/lib/carin_for_blue_button_test_kit/generator/templates/group.rb.erb +7 -1
  78. data/lib/carin_for_blue_button_test_kit/generator/templates/suite.rb.erb +21 -1
  79. 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
  80. data/lib/carin_for_blue_button_test_kit/requirements/generated/c4bb_v110_requirements_coverage.csv +1 -0
  81. data/lib/carin_for_blue_button_test_kit/requirements/generated/c4bb_v200_client_requirements_coverage.csv +47 -0
  82. 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
  83. data/lib/carin_for_blue_button_test_kit/requirements/generated/c4bb_v200devnonfinancial_requirements_coverage.csv +244 -0
  84. data/lib/carin_for_blue_button_test_kit/requirements/hl7.fhir.us.carin-bb_2.0.0_reqs.xlsx +0 -0
  85. data/lib/carin_for_blue_button_test_kit/version.rb +2 -2
  86. data/lib/carin_for_blue_button_test_kit.rb +0 -1
  87. metadata +80 -15
  88. data/lib/carin_for_blue_button_test_kit/requirements/carin-for-blue-button-test-kit_out_of_scope_requirements.csv +0 -68
  89. data/lib/inferno_requirements_tools/ext/inferno_core/runnable.rb +0 -22
  90. data/lib/inferno_requirements_tools/rake/rakefile_template +0 -31
  91. data/lib/inferno_requirements_tools/tasks/requirements_coverage.rb +0 -284
  92. data/lib/requirements_config.yaml +0 -17
@@ -1,278 +1,244 @@
1
- Req Set,ID,URL,Requirement,Conformance,Actor,Sub-Requirement(s),Conditionality,CARIN IG for Blue Button® v2.0.0 Client Test Suite Short ID(s),CARIN IG for Blue Button® v2.0.0 Client Test Suite Full ID(s),CARIN IG for Blue Button® v2.0.0 Short ID(s),CARIN IG for Blue Button® v2.0.0 Full ID(s)
2
- hl7.fhir.us.carin-bb_2.0.0,1,https://hl7.org/fhir/us/carin-bb/STU2/Background.html#smart-application-launch,The CARIN IG for Blue Button® requires the use of the SMART App Launch Framework’s standalone launch sequence as it will clarify that applications maintain a patient context for the duration of the connection.,SHALL,Health Plan/Consumer,,false,"","",1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
1
+ 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)
2
+ hl7.fhir.us.carin-bb_2.0.0,1,https://hl7.org/fhir/us/carin-bb/STU2/Background.html#smart-application-launch,The CARIN IG for Blue Button® requires the use of the SMART App Launch Framework’s standalone launch sequence as it will clarify that applications maintain a patient context for the duration of the connection.,SHALL,"Health Plan,Consumer",false,,,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
3
3
  hl7.fhir.us.carin-bb_2.0.0,2,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,"When querying and reading CARIN IG for Blue Button® Profiles, *Must Support* on any profile data element SHALL be interpreted as follows: ...
4
4
 
5
- Health Plan API actors SHALL be capable of populating all data elements the payer maintains as part of the query results as specified by the CARINBlueButtonHealthPlanAPICapabilityStatement.",SHALL,Health Plan,,false,NA,NA,,
6
- hl7.fhir.us.carin-bb_2.0.0,3,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,[*Must Support* on profile data elements means] Consumer App actors SHALL be capable of processing resource instances containing the data elements without generating an error or causing the application to fail.,SHALL,Consumer,,false,8.01,c4bb_v200_client-c4bb_client_attestation_test_group-client_claims_data_attestation,NA,NA
7
- hl7.fhir.us.carin-bb_2.0.0,4,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,[*Must Support* on profile data elements means] Consumer App actors SHALL be capable of displaying the data elements for human use.,SHALL,Consumer,,false,,,NA,NA
5
+ Health Plan API actors SHALL be capable of populating all data elements the payer maintains as part of the query results as specified by the CARINBlueButtonHealthPlanAPICapabilityStatement.",SHALL,Health Plan,false,,,3.2.01,c4bb_v200-c4bb_server_v200_visual_inspection_and_attestation-c4bb_must_support-carin_server_requirement_2_attestation
8
6
  hl7.fhir.us.carin-bb_2.0.0,5,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,"When querying and reading CARIN IG for Blue Button® Profiles, *Must Support* on any profile data element SHALL be interpreted as follows:...
9
7
 
10
- In situations where information on a particular data element is not present and the reason for absence is unknown, Health Plan API actors SHALL NOT include the data elements in the resource instance returned as part of the query results.",SHALL NOT,Health Plan,,true,NA,NA,,
11
- hl7.fhir.us.carin-bb_2.0.0,6,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,"[*Must Support* on profile data elements means w]hen querying Health Plan API actors, Consumer App actors SHALL interpret missing data elements within resource instances as data not present in the Health Plan API actors system.",SHALL,Consumer,,false,,,NA,NA
8
+ 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
12
9
  hl7.fhir.us.carin-bb_2.0.0,7,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,"When querying and reading CARIN IG for Blue Button® Profiles, *Must Support* on any profile data element SHALL be interpreted as follows: ...
13
10
 
14
- In situations where information on a particular data element is missing and the Health Plan API actor knows the precise reason for the absence of data, Health Plan API actors SHALL send the reason for the missing information using values (such as nullFlavors) from the value set where they exist or use the dataAbsentReason extension.",SHALL,Health Plan,,true,NA,NA,Not Tested,Not Tested
15
- hl7.fhir.us.carin-bb_2.0.0,8,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#must-support,[*Must Support* on profile data elements means] Consumer App actors SHALL be able to process resource instances containing data elements asserting missing information.,SHALL,Consumer,,false,,,NA,NA
16
- hl7.fhir.us.carin-bb_2.0.0,9,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#missing-data,"If the source system does not have data for a *Must Support* data element with minimum cardinality = 0, the data element is omitted from the resource.",SHALL,Health Plan,,true,NA,NA,,
17
- hl7.fhir.us.carin-bb_2.0.0,10,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#missing-data,"If the source system does not have data for a required data element (in other words, where the minimum cardinality is > 0), follow guidance defined in the core FHIR specification and summarized in the US Core.",SHALL,Health Plan,"hl7.fhir.us.core_7.0.0,hl7.fhir_4.0.1",true,NA,NA,,
11
+ 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
12
+ 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
13
+ 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
18
14
  hl7.fhir.us.carin-bb_2.0.0,11,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#conformance-to-us-core-profiles,"Any actor acting as a Health Plan API actor in this IG SHALL:…
19
15
 
20
- Be able to populate all profile data elements that have a minimum cardinality >= 1 and/or flagged as *Must Support* as defined by that profiles StructureDefinition.",SHALL,Health Plan,,false,NA,NA,"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"
16
+ 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"
21
17
  hl7.fhir.us.carin-bb_2.0.0,12,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#conformance-to-us-core-profiles,"Any actor acting as a Health Plan API actor in this IG SHALL:…
22
18
 
23
- Conform to the US Core Health Plan Capability Statement expectations for that profile's type.",SHALL,Health Plan,,false,NA,NA,"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"
24
- hl7.fhir.us.carin-bb_2.0.0,13,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#conformance-to-us-core-profiles,Any actor acting [as] a FHIR Client in this IG SHALL … [b]e able to process and retain all profile data elements that have a minimum cardinality >= 1 and/or flagged as Must Support as defined by that profiles StructureDefinition.,SHALL,Consumer,,false,8.01,c4bb_v200_client-c4bb_client_attestation_test_group-client_claims_data_attestation,NA,NA
25
- hl7.fhir.us.carin-bb_2.0.0,14,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#conformance-to-us-core-profiles,Any actor acting [as] a FHIR Client in this IG SHALL [c]onform to the US Core Client Capability Statement expectations for that profiles type.,SHALL,Consumer,,false,"2.02, 3.02, 4.02, 5.02, 6.02, 7.06","c4bb_v200_client-c4bb_patient_profile_test_group-patient_required_searches, c4bb_v200_client-c4bb_coverage_profile_test_group-coverage_required_searches, c4bb_v200_client-c4bb_organization_profile_test_group-organization_required_searches, c4bb_v200_client-c4bb_practitioner_profile_test_group-practitioner_required_searches, c4bb_v200_client-c4bb_relatedperson_profile_test_group-relatedperson_required_searches, c4bb_v200_client-c4bb_explanationofbenefit_profiles_test_group-eob_required_searches",NA,NA
26
- hl7.fhir.us.carin-bb_2.0.0,15,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#profiling-constraints,"Data element that are not part of this scope have not been constrained out, and as such, may be included by the Health Plan API.",MAY,Health Plan,,false,NA,NA,Not Tested,Not Tested
27
- hl7.fhir.us.carin-bb_2.0.0,16,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#profiling-constraints,"If a Health Plan API includes additional information, there SHALL be no expectation that client applications support the data in any way in order to be conformant with this specification.",SHALL NOT,Consumer,,true,Not Tested,Not Tested,NA,NA
28
- hl7.fhir.us.carin-bb_2.0.0,17,http://hl7.org/fhir/us/carin-bb/STU2/Conformance_Requirements.html#capabilitystatement-Health Plan-requirement,Health Plans claiming conformance to this guide SHALL include a CapabilityStatement that has a CapabilityStatement.instantiates with a URL of http://hl7.org/fhir/us/carin-bb/CapabilityStatement/c4bb or a URL to the appropriate version of the CapabilityStatement.,SHALL,Health Plan,,false,NA,NA,2.1.04,c4bb_v200-Group02-capability_statement_group-carin_bb_instantiate
29
- hl7.fhir.us.carin-bb_2.0.0,18,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,payers **MAY** choose to provide a concept text `[CodeableConcept].text` or the coding display `[CodeableConcept].coding.display.`,MAY,Health Plan,,false,NA,NA,Not Tested,Not Tested
30
- hl7.fhir.us.carin-bb_2.0.0,19,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"If the ‘display’ element is populated, the string used in `display` **SHALL** be one of the display strings defined for that code by the code system (code systems may define multiple display strings for a single code).",SHALL,Health Plan,,true,NA,NA,,
31
- hl7.fhir.us.carin-bb_2.0.0,20,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"If the code description available is not known to be an exact match of a display string defined by the code system, the `[CodeableConcept].text` should be used in place of the `[CodeableConcept].coding.display`.",SHOULD,Health Plan,,true,NA,NA,Not Tested,Not Tested
32
- hl7.fhir.us.carin-bb_2.0.0,21,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,Payers **MAY** choose to also provide resource level text to enable consumers apps to render resources in a manner that the payer would like to have the data presented.,MAY,Health Plan,,false,NA,NA,Not Tested,Not Tested
33
- hl7.fhir.us.carin-bb_2.0.0,22,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,The `[Resource].text` is a Narrative datatype that has a `div` element that is an xhtml datatype. This element **MAY** be used to provide an easily renderable version of the resource that is meant for human viewing.,MAY,Health Plan,,false,NA,NA,Not Tested,Not Tested
34
- hl7.fhir.us.carin-bb_2.0.0,23,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,Payers may also provide additional data elements beyond what is in this guide.,MAY,Health Plan,,false,NA,NA,Not Tested,Not Tested
35
- hl7.fhir.us.carin-bb_2.0.0,24,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"Payers SHOULD include descriptions of the data elements they provide, particularly for data elements not covered in this guide",SHOULD,Health Plan,,false,NA,NA,Not Tested,Not Tested
36
- hl7.fhir.us.carin-bb_2.0.0,25,http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#considerations-for-improving-interoperability,"As part of their API documentation, Payers may consider providing a display mapping like can be found in the [Example Printed Explanation Of Benefit Mapping](http://hl7.org/fhir/us/carin-bb/STU2/General_Guidance.html#example-printed-eob-mapping) section of this implementation guide.",MAY,Health Plan,,false,NA,NA,Not Tested,Not Tested
37
- 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,NA,NA,Not Tested,Not Tested
38
- 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,NA,NA,,
39
- 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,NA,NA,,
40
- 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,NA,NA,,
41
- 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,,,,
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/Consumer,,false,Not Tested,Not Tested,Not Tested,Not Tested
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/Consumer,,false,,,,
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/Consumer,,false,,,,
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,,false,NA,NA,,
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/Consumer,,false,,,,
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,hl7.fhir.us.core_7.0.0,false,NA,NA,,
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,,false,NA,NA,1.1,c4bb_v200-c4bb_v200_smart_launch-smart_discovery
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/Consumer,,false,Not Tested,Not Tested,Not Tested,Not Tested
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,1.2,c4bb_v200-c4bb_v200_smart_launch-smart_standalone_launch
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,,false,NA,NA,Not Tested,Not Tested
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/Consumer,,true,,,,
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,,false,NA,NA,Not Tested,Not Tested
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,,false,NA,NA,Not Tested,Not Tested
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,Not Tested,Not Tested
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,,false,NA,NA,,
102
- hl7.fhir.us.carin-bb_2.0.0,90,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#root,Apps will use the meta.lastUpdated values to determine if the reference resources are as of the current date or date of service.,SHALL,Consumer,,false,,,NA,NA
103
- 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,NA,NA,Not Tested,Not Tested
104
- 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,NA,NA,Not Tested,Not Tested
105
- 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,NA,NA,Not Tested,Not Tested
106
- hl7.fhir.us.carin-bb_2.0.0,94,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#title,Apps will use the meta.lastUpdated values to determine if the reference resources are as of the current date or date of service.,SHALL,Consumer,,false,Not Tested,Not Tested,NA,NA
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,,false,NA,NA,,
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,,false,NA,NA,2.1.03,c4bb_v200-Group02-capability_statement_group-carin_bb_json_support
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,,false,NA,NA,,
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,,false,NA,NA,"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"
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,2.3,c4bb_v200-Group02-c4bb_v200_eob
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,,false,NA,NA,Not Tested,Not Tested
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,,false,NA,NA,,
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,,false,NA,NA,Not Tested,Not Tested
124
- hl7.fhir.us.carin-bb_2.0.0,107,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,Clients MAY request referenced resources as part of an EOB search (by supplying the _include parameter) or directly using read or vread.,MAY,Consumer,,false,Not Tested,Not Tested,NA,NA
125
- 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,NA,NA,,
126
- hl7.fhir.us.carin-bb_2.0.0,109,http://hl7.org/fhir/us/carin-bb/STU2/CapabilityStatement-c4bb.html#explanationofbenefit,"“:iterate"" should be used if you request to include Coverage:payor in the EOB response bundle, e.g. GET [base]/ExplanationOfBenefit?_id[parameter=value]&_include=ExplanationOfBenefit:coverage&_include:iterate=Coverage:payor.",SHOULD,Consumer,,false,,,NA,NA
127
- 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,NA,NA,,
128
- 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,NA,NA,,
129
- 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,NA,NA,2.3.17,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_validation_test
130
- 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,NA,NA,,
131
- 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,NA,NA,2.3.17,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_validation_test
132
- 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,NA,NA,,
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,,true,NA,NA,Not Tested,Not Tested
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,,true,NA,NA,Not Tested,Not Tested
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,,false,NA,NA,Not Tested,Not Tested
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,,false,NA,NA,Not Tested,Not Tested
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,,false,NA,NA,,
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,,true,NA,NA,,
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,,false,NA,NA,Not Tested,Not Tested
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,,true,NA,NA,,
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,,true,NA,NA,,
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,,false,NA,NA,,
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,,true,NA,NA,Not Tested,Not Tested
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,,false,NA,NA,2.3.17,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_validation_test
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,,false,NA,NA,Not Tested,Not Tested
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,,false,NA,NA,2.3.19,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_inpatient_institutional_validation_test
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,,false,NA,NA,2.3.19,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_inpatient_institutional_validation_test
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,,false,NA,NA,,
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,,false,NA,NA,2.3.19,c4bb_v200-Group02-c4bb_v200_eob-c4bb_v200_eob_inpatient_institutional_validation_test
186
- hl7.fhir.us.carin-bb_2.0.0,137,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields,".diagnosis.sequence rule:
187
-
188
- Client app implementations should not assign any significance to the sequence values.",SHOULD NOT,Consumer,,false,Not Tested,Not Tested,NA,NA
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,true,NA,NA,,
210
- hl7.fhir.us.carin-bb_2.0.0,147,http://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Oral.html#notes-on-fields,".diagnosis.sequence rule: diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. Client app implementations should not assign any significance to the sequence values. Client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.",SHOULD NOT,Consumer,,false,Not Tested,Not Tested,NA,NA
211
- 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,NA,NA,Not Tested,Not Tested
212
- 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,NA,NA,Not Tested,Not Tested
213
- 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,NA,NA,,
214
- 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,NA,NA,,
215
- 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,NA,NA,,
216
- 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,NA,NA,,
217
- 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,NA,NA,Not Tested,Not Tested
218
- 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,NA,NA,Not Tested,Not Tested
219
- 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,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,true,NA,NA,,
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,,true,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,true,NA,NA,,
243
- hl7.fhir.us.carin-bb_2.0.0,166,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,.diagnosis.sequence rule: diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. Client app implementations should not assign any significance to the sequence values.,SHOULD NOT,Consumer,,false,Not Tested,Not Tested,NA,NA
244
- hl7.fhir.us.carin-bb_2.0.0,167,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-ExplanationOfBenefit-Professional-NonClinician.html#notes-on-fields,".diagnosis.sequence rule: diagnosis.sequence values do not necessarily indicate any order in which the diagnosis was reported or identified. ...Client app implementations should use the values of diagnosis.type to identify primary, secondary, etc.",SHOULD,Consumer,,false,Not Tested,Not Tested,NA,NA
245
- 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,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,,
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,,false,NA,NA,Not Tested,Not Tested
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,,false,NA,NA,,
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,,false,NA,NA,Not Tested,Not Tested
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,,true,NA,NA,,
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,,true,NA,NA,,
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,,false,NA,NA,,
261
- hl7.fhir.us.carin-bb_2.0.0,180,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Organization.html,.meta.lastUpdated: ... Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.,SHALL,Consumer,,false,Not Tested,Not Tested,NA,NA
262
- 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,NA,NA,Not Tested,Not Tested
263
- 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,NA,NA,Not Tested,Not Tested
264
- 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,NA,NA,,
265
- hl7.fhir.us.carin-bb_2.0.0,184,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Patient.html#notes-on-fields,.meta.lastUpdated: ... Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.,SHALL,Consumer,,false,Not Tested,Not Tested,NA,NA
266
- 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,NA,NA,Not Tested,Not Tested
267
- 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,NA,NA,,
268
- 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,NA,NA,,
269
- hl7.fhir.us.carin-bb_2.0.0,188,https://hl7.org/fhir/us/carin-bb/STU2/StructureDefinition-C4BB-Practitioner.html#notes-on-fields,.meta.lastUpdated: Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.,SHALL,Consumer,,false,Not Tested,Not Tested,NA,NA
270
- hl7.fhir.us.carin-bb_2.0.0,189,https://hl7.org/fhir/us/carin-bb/STU2/,COMPUTABLE REQUIREMENTS TBD,,Health Plan,,,NA,NA,,
271
- 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,NA,NA,Not Tested,Not Tested
272
- 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,NA,NA,Not Tested,Not Tested
273
- 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,NA,NA,Not Tested,Not Tested
274
- 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,NA,NA,Not Tested,Not Tested
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