Independence Blue Cross · Schema

IBX ExplanationOfBenefit (CARIN BB subset)

Operational subset of the FHIR R4 ExplanationOfBenefit resource as published by Independence Blue Cross at https://eapics.ibx.com/patient/v1/fhir/ExplanationOfBenefit. Supports the CARIN BB inpatient, outpatient, pharmacy, professional, and oral institutional/professional profiles (CapabilityStatement lists five supported profiles).

HealthcareHealth InsuranceBlue Cross Blue ShieldManaged CareMedicareMedicare AdvantageMedicaidCHIPCommercialDentalVisionBehavioral HealthPharmacy BenefitsInteroperabilityFHIRSMART On FHIRCMSPatient AccessProvider DirectoryDrug FormularyTransparency In Coverage

Properties

Name Type Description
resourceType string
id string
status string
type object Claim type (institutional, professional, pharmacy, oral, vision).
subType object
use string
patient object Reference to Patient.
billablePeriod object
created string
insurer object Reference to IBX/Keystone/QCC/IAC payer organization.
provider object
outcome string
insurance array
item array
total array
payment object
View JSON Schema on GitHub

JSON Schema

independence-blue-cross-explanation-of-benefit-schema.json Raw ↑ 
{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$id": "https://raw.githubusercontent.com/api-evangelist/independence-blue-cross/refs/heads/main/json-schema/independence-blue-cross-explanation-of-benefit-schema.json",
  "title": "IBX ExplanationOfBenefit (CARIN BB subset)",
  "description": "Operational subset of the FHIR R4 ExplanationOfBenefit resource as published by Independence Blue Cross at https://eapics.ibx.com/patient/v1/fhir/ExplanationOfBenefit. Supports the CARIN BB inpatient, outpatient, pharmacy, professional, and oral institutional/professional profiles (CapabilityStatement lists five supported profiles).",
  "type": "object",
  "required": ["resourceType", "id", "status", "type", "patient"],
  "properties": {
    "resourceType": {"type": "string", "const": "ExplanationOfBenefit"},
    "id": {"type": "string"},
    "status": {"type": "string", "enum": ["active", "cancelled", "draft", "entered-in-error"]},
    "type": {"type": "object", "description": "Claim type (institutional, professional, pharmacy, oral, vision)."},
    "subType": {"type": "object"},
    "use": {"type": "string", "enum": ["claim", "preauthorization", "predetermination"]},
    "patient": {"type": "object", "description": "Reference to Patient."},
    "billablePeriod": {
      "type": "object",
      "properties": {
        "start": {"type": "string", "format": "date"},
        "end": {"type": "string", "format": "date"}
      }
    },
    "created": {"type": "string", "format": "date-time"},
    "insurer": {"type": "object", "description": "Reference to IBX/Keystone/QCC/IAC payer organization."},
    "provider": {"type": "object"},
    "outcome": {"type": "string", "enum": ["queued", "complete", "error", "partial"]},
    "insurance": {
      "type": "array",
      "items": {
        "type": "object",
        "properties": {
          "focal": {"type": "boolean"},
          "coverage": {"type": "object"}
        }
      }
    },
    "item": {
      "type": "array",
      "items": {"type": "object"}
    },
    "total": {
      "type": "array",
      "items": {
        "type": "object",
        "properties": {
          "category": {"type": "object"},
          "amount": {
            "type": "object",
            "properties": {
              "value": {"type": "number"},
              "currency": {"type": "string"}
            }
          }
        }
      }
    },
    "payment": {"type": "object"}
  },
  "x-fhir-version": "4.0.1",
  "x-source-capability-statement": "https://eapics.ibx.com/patient/v1/fhir/metadata",
  "x-supported-profiles": [
    "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional",
    "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional",
    "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy",
    "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician",
    "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral"
  ]
}