CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®)
0.1.10 - STU1

CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) - Local Development build (v0.1.10). See the Directory of published versions

Resource Profile: C4BB Patient

Defining URL:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient
Version:0.1.10
Name:C4BBPatient
Title:C4BB Patient
Status:Active as of 2020-11-12T01:33:42+00:00
Definition:

This profile builds upon the US Core Patient profile. It is used to convey information about the patient who received the services described on the claim.

Publisher:HL7 Financial Management Working Group
Source Resource:XML / JSON / Turtle

The official URL for this profile is:

http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient

Notes on Fields

  • The Patient FHIR Resource defines a comprehensive set of data elements.  Many of them are not relevant to this use case.  When reviewing the Profile Snapshot, several data elements previously hidden are now exposed.  Fields intended for consideration to be provided in the API are marked as Must Support; i.e., a red S or have a minimum cardinality of 1.  All other data elements are not expected to be sent by a Responder; if they are sent a Requestor can choose to ignore them
  • 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.
  • Payers may decide to provide either the data that was in effect as of the date of service or the current data.
  • .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. Apps will use the meta.lastUpdated value to determine if the Reference resources are as of the current date or date of service.
  • The numbers, e.g. (1), following the data element descriptions correlate to the MapID in the CPCDS Data Dictionary and the Mapping Worksheet as described here.

 

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from USCorePatientProfile

Summary

Mandatory: 5 elements (3 nested mandatory elements)
Must-Support: 6 elements

Slices

This structure defines the following Slices:

  • The element Patient.identifier is sliced based on the value of pattern:type
  • The element Patient.deceased[x] is sliced based on the value of type:$this

 

Other representations of profile: Schematron

Terminology Bindings

PathConformanceValueSet / Code
Patient.meta.securityextensibleAll Security Labels
Patient.meta.tagexampleCommonTags
Patient.languagepreferredCommonLanguages
Max Binding: AllLanguages
Patient.identifier.userequiredIdentifierUse
Patient.identifier.typeextensibleC4BBPatientIdentifierType
Patient.identifier:memberid.userequiredIdentifierUse
Patient.identifier:memberid.typeextensiblePattern: MB
Patient.identifier:medrecnum.userequiredIdentifierUse
Patient.identifier:medrecnum.typeextensiblePattern: MR
Patient.identifier:uniquememberid.userequiredIdentifierUse
Patient.identifier:uniquememberid.typeextensiblePattern: um
Patient.identifier:patacctnum.userequiredIdentifierUse
Patient.identifier:patacctnum.typeextensiblePattern: pat
Patient.name.userequiredNameUse
Patient.telecom.systemrequiredContactPointSystem
Patient.telecom.userequiredContactPointUse
Patient.genderrequiredAdministrativeGender
Patient.address.userequiredAddressUse
Patient.address.typerequiredAddressType
Patient.address.stateextensibleUspsTwoLetterAlphabeticCodes
Patient.maritalStatusextensibleMarital Status Codes
Patient.contact.relationshipextensiblePatientContactRelationship
Patient.contact.genderrequiredAdministrativeGender
Patient.communication.languageextensibleLanguageCodesWithLanguageAndOptionallyARegionModifier
Patient.link.typerequiredLinkType

Constraints

IdPathDetailsRequirements
pat-1Patient.contactSHALL at least contain a contact's details or a reference to an organization
: name.exists() or telecom.exists() or address.exists() or organization.exists()