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Last active Sep 15, 2019

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CARIN Blue Button Examples from FHIR 2019-09 Connectathon
{
"resourceType": "Bundle",
"type": "searchset",
"total": 3,
"link": [
{
"relation": "self",
"url": "https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-r4/ExplanationOfBenefit?patient=d4b1d050-584f-4797-a9c7-ab72e4cd4452&_count=20"
},
{
"relation": "first",
"url": "https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-r4/ExplanationOfBenefit?_query=d0ecbb1b-0fc3-4f10-aecf-47f7e4b096ca&_count=20&_start=1"
}
],
"entry": [
{
"fullUrl": "https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-r4/ExplanationOfBenefit/6f978df0-3121-e611-8128-0a69c1b3225b",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "6f978df0-3121-e611-8128-0a69c1b3225b",
"meta": {
"lastUpdated": "2016-05-23T22:01:59.137+00:00"
},
"identifier": [
{
"use": "usual",
"value": "123456780C3"
}
],
"_status": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode": "unsupported"
},
{
"url": "http://careevolution.com/fhirextensions#term",
"valueCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ClaimStatus",
"code": "PAID",
"display": "PAID",
"userSelected": true
}
],
"text": "PAID"
}
}
]
},
"type": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ClaimType",
"code": "Institutional",
"display": "Institutional",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/FhirCodes/ClaimType",
"code": "institutional",
"display": "Institutional",
"userSelected": false
},
{
"system": "http://hl7.org/fhir/ex-claimtype",
"code": "institutional"
}
],
"text": "Institutional"
},
"patient": {
"reference": "Patient/d4b1d050-584f-4797-a9c7-ab72e4cd4452"
},
"billablePeriod": {
"start": "2012-08-31T00:00:00-04:00",
"end": "2012-09-10T00:00:00-04:00"
},
"item": [
{
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/MedicationType",
"code": "CALCIUM CARB 1250MG/5ML",
"userSelected": true
}
]
},
"servicedDate": "2012-09-16"
},
{
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/MedicationType",
"code": "ALBUTEROL 90MCG INHALER",
"userSelected": true
}
]
},
"servicedDate": "2012-09-16"
},
{
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/MedicationType",
"code": "PREVACID 30MG CAPSULE DR.",
"userSelected": true
}
]
},
"servicedDate": "2012-09-16"
},
{
"productOrService": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/MedicationType",
"code": "NORVASC 5MG TABLET",
"userSelected": true
}
]
},
"servicedDate": "2012-09-16"
}
],
"payment": {
"amount": {
"value": 3000.54
}
}
},
"search": {
"mode": "match"
}
},
{
"fullUrl": "https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-r4/ExplanationOfBenefit/41978df0-3121-e611-8128-0a69c1b3225b",
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "41978df0-3121-e611-8128-0a69c1b3225b",
"meta": {
"lastUpdated": "2016-05-23T22:01:55.57+00:00"
},
"identifier": [
{
"use": "usual",
"value": "123456780C2"
}
],
"_status": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode": "unsupported"
},
{
"url": "http://careevolution.com/fhirextensions#term",
"valueCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ClaimStatus",
"code": "PAID",
"display": "PAID",
"userSelected": true
}
],
"text": "PAID"
}
}
]
},
"type": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/ClaimType",
"code": "Institutional",
"display": "Institutional",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/FhirCodes/ClaimType",
"code": "institutional",
"display": "Institutional",
"userSelected": false
},
{
"system": "http://hl7.org/fhir/ex-claimtype",
"code": "institutional"
}
],
"text": "Institutional"
},
"patient": {
"reference": "Patient/d4b1d050-584f-4797-a9c7-ab72e4cd4452"
},
"billablePeriod": {
"start": "2013-09-01T00:00:00-04:00",
"end": "2013-09-11T00:00:00-04:00"
},
"careTeam": [
{
"provider": {
"reference": "Practitioner/df968df0-3121-e611-8128-0a69c1b3225b"
},
"role": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/CaregiverRelationshipType",
"code": "ClaimProvider",
"display": "Claim Provider",
"userSelected": true
}
],
"text": "Claim Provider"
}
},
{
"provider": {
"reference": "Practitioner/de968df0-3121-e611-8128-0a69c1b3225b"
},
"role": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/CaregiverRelationshipType",
"code": "PayToProvider",
"display": "Pay To Provider",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/CaregiverRelationshipType",
"code": "PayToProvider",
"display": "Pay To Provider",
"userSelected": false
}
],
"text": "Pay To Provider"
}
}
],
"diagnosis": [
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 1,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "518.84",
"display": "ACUTE&CHRONIC RESPIRATORY FAILURE",
"userSelected": true
}
],
"text": "ACUTE&CHRONIC RESPIRATORY FAILURE"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "Primary",
"display": "Primary Diagnosis",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Primary",
"display": "Primary",
"userSelected": false
}
],
"text": "Primary Diagnosis"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 2,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "491.21",
"display": "OBST CHRONIC BRONCHITIS W_EXACERBAT",
"userSelected": true
}
],
"text": "OBST CHRONIC BRONCHITIS W_EXACERBAT"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "Admit",
"display": "Admit",
"userSelected": true
}
],
"text": "Admit"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 3,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "416.2",
"display": "CHRONIC PULMONARY EMBOLISM",
"userSelected": true
}
],
"text": "CHRONIC PULMONARY EMBOLISM"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 4,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "599.0",
"display": "UTI SITE NOT SPECIFIED",
"userSelected": true
}
],
"text": "UTI SITE NOT SPECIFIED"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 5,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "584.9",
"display": "ACUTE KIDNEY FAILURE UNSPECIFIED",
"userSelected": true
}
],
"text": "ACUTE KIDNEY FAILURE UNSPECIFIED"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 6,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "491.22",
"display": "OBST CHRN BRONCHITIS W/AC BRONCHIT",
"userSelected": true
}
],
"text": "OBST CHRN BRONCHITIS W/AC BRONCHIT"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 7,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "V85.43",
"display": "BODY MASS INDEX 50.0-59.9 ADULT",
"userSelected": true
}
],
"text": "BODY MASS INDEX 50.0-59.9 ADULT"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 8,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "428.32",
"display": "CHRONIC DIASTOLIC HEART FAILURE",
"userSelected": true
}
],
"text": "CHRONIC DIASTOLIC HEART FAILURE"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 9,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "278.01",
"display": "MORBID OBESITY",
"userSelected": true
}
],
"text": "MORBID OBESITY"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 10,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "305.1",
"display": "NONDEPENDENT TOBACCO USE DISORDER",
"userSelected": true
}
],
"text": "NONDEPENDENT TOBACCO USE DISORDER"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 11,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "714.0",
"display": "RHEUMATOID ARTHRITIS",
"userSelected": true
}
],
"text": "RHEUMATOID ARTHRITIS"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 12,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "458.9",
"display": "UNSPECIFIED HYPOTENSION",
"userSelected": true
}
],
"text": "UNSPECIFIED HYPOTENSION"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 13,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "276.7",
"display": "HYPERPOTASSEMIA",
"userSelected": true
}
],
"text": "HYPERPOTASSEMIA"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 14,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "428.0",
"display": "CHF UNSPECIFIED",
"userSelected": true
}
],
"text": "CHF UNSPECIFIED"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 15,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "250.02",
"display": "DB W_O COMP TYPE II_UNS UNCNTRL",
"userSelected": true
}
],
"text": "DB W_O COMP TYPE II_UNS UNCNTRL"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 16,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "784.0",
"display": "HEADACHE",
"userSelected": true
}
],
"text": "HEADACHE"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 17,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "041.4",
"display": "E COLI INFECTION CCE and UNS SITE",
"userSelected": true
}
],
"text": "E COLI INFECTION CCE and UNS SITE"
},
"type": [
{
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisType",
"code": "SECONDARY",
"display": "SECONDARY",
"userSelected": true
},
{
"system": "http://fhir.carevolution.com/codes/CareEvolution/DiagnosisType",
"code": "Secondary",
"display": "Secondary",
"userSelected": false
}
],
"text": "SECONDARY"
}
]
},
{
"extension": [
{
"url": "http://careevolution.com/fhirextensions#claim-problemDate",
"valueDateTime": "2013-09-01T00:00:00-04:00"
}
],
"sequence": 18,
"diagnosisCodeableConcept": {
"coding": [
{
"system": "http://fhir.carevolution.com/codes/DemoNamespace/DiagnosisCode",
"code": "530.81",
"display": "ESOPHAGEAL REFLUX",
"userSelected": true
}
],
"text": "ESOPHAGEAL REFLUX"
},
"type": [
{
"coding": [
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"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [
{
"system": "https://www.cms.gov/Medicare/Coding/MedHCPCSGenInfo",
"code": "88888"
}
]
},
"servicedDate": "2018-05-09",
"quantity": {
"value": 9,
"unit": "UN"
}
},
{
"sequence": 5,
"revenue": {
"coding": [
{
"system": "http://hl7.org/fhir/ValueSet/ex-revenue-center",
"code": "0301"
}
]
},
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/benefit-subcategory",
"code": "1",
"display": "Medical Services"
}
]
},
"productOrService": {
"coding": [