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

{
  "$schema": "https://json-schema.org/draft/2020-12/schema",
  "$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"
  ]
}

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