Independence Blue Cross · Example Payload

Independence Blue Cross Explanation Of Benefit Search Example

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Independence Blue Cross Explanation Of Benefit Search Example is an example object payload from Independence Blue Cross, with 6 top-level fields. It illustrates the shape of data this provider's APIs accept or return.

Top-level fields

_exampleresourceTypetypetotallinkentry

Example Payload

Raw ↑ 
{
  "_example": {
    "description": "Search ExplanationOfBenefit (claims) for an IBX member, filtered by professional claim type and service date range.",
    "request": {
      "method": "GET",
      "url": "https://eapics.ibx.com/patient/v1/fhir/ExplanationOfBenefit?patient=example-ibx-member-1&type=professional&service-date=ge2025-01-01",
      "headers": {
        "Accept": "application/fhir+json",
        "Authorization": "Bearer eyJhbGciOiJSUzI1NiIs...<member access token>..."
      }
    },
    "response_status": 200
  },
  "resourceType": "Bundle",
  "type": "searchset",
  "total": 1,
  "link": [
    {"relation": "self", "url": "https://eapics.ibx.com/patient/v1/fhir/ExplanationOfBenefit?patient=example-ibx-member-1&type=professional"}
  ],
  "entry": [
    {
      "fullUrl": "https://eapics.ibx.com/patient/v1/fhir/ExplanationOfBenefit/example-eob-1",
      "resource": {
        "resourceType": "ExplanationOfBenefit",
        "id": "example-eob-1",
        "meta": {
          "profile": [
            "http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician"
          ]
        },
        "status": "active",
        "type": {
          "coding": [
            {"system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "professional", "display": "Professional"}
          ]
        },
        "use": "claim",
        "patient": {"reference": "Patient/example-ibx-member-1"},
        "billablePeriod": {"start": "2025-02-04", "end": "2025-02-04"},
        "created": "2025-02-12T11:08:00-05:00",
        "insurer": {"display": "Keystone Health Plan East"},
        "provider": {"display": "Penn Medicine Internal Medicine - Center City"},
        "outcome": "complete",
        "insurance": [{"focal": true, "coverage": {"reference": "Coverage/example-coverage-1"}}],
        "item": [
          {
            "sequence": 1,
            "productOrService": {
              "coding": [{"system": "http://www.ama-assn.org/go/cpt", "code": "99214", "display": "Office visit, established patient, moderate complexity"}]
            },
            "servicedDate": "2025-02-04"
          }
        ],
        "total": [
          {
            "category": {"coding": [{"code": "submitted", "system": "http://terminology.hl7.org/CodeSystem/adjudication"}]},
            "amount": {"value": 188.00, "currency": "USD"}
          },
          {
            "category": {"coding": [{"code": "benefit", "system": "http://terminology.hl7.org/CodeSystem/adjudication"}]},
            "amount": {"value": 148.00, "currency": "USD"}
          }
        ]
      }
    }
  ]
}