API end point: https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-stu3.

Resource ExplanationOfBenefit (STU3)

Maps CareEvolution Claim and contained Medication concepts

Supported interactions

Search parameters

Name Type Modifiers , prefixes Multiple values Can be chained Description
_id Token Yes See here
_lastUpdated Date lt le gt ge See here
_source Token :missing Yes See here
care-team Reference :missing Yes Yes

Member of the CareTeam

coverage Reference :missing Yes Yes

The plan under which the claim was adjudicated

encounter Reference :missing Yes Yes

Encounters associated with a billed line item

identifier Token :missing Yes

The business identifier of the Explanation of Benefit

patient Reference :missing Yes Yes

The reference to the patient

provenance-agent Reference :missing Yes Yes

Search by provenance, specified by its author (aka originator) Organization

service-date Date :missing eq ne lt le gt ge sa eb ap See here
type Token :missing Yes See here

Sorts

Supports multiple sorts

Includes

Operations

To FHIR mappings

FHIR CareEvolution
billablePeriod Claim.StartDate
Claim.EndDate
billablePeriod.extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-claim-query-cd-extension.html') Claim.Property('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-claim-query-cd-extension.html')
billablePeriod.extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension.html') Claim.Property('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension.html')
billablePeriod.extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-snf-claim-query-cd-extension.html') Claim.Property('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-snf-claim-query-cd-extension.html')
careTeam.provider Claim.CaregiverRelationships.CaregiverID Excludes CaregiverRelationships with RelationshipType equal to ClaimProvider or PayToProvider
Claim.Services.CaregiverRelationships.CaregiverID
careTeam.role
Bindings:  valueset-claim-careteamrole
Claim.CaregiverRelationships.RelationshipType
Domain: CaregiverRelationshipType
Excludes CaregiverRelationships with RelationshipType equal to ClaimProvider or PayToProvider
Claim.Services.CaregiverRelationships.RelationshipType
Domain: CaregiverRelationshipType
diagnosis.diagnosis
Bindings:  http://hl7.org/fhir/sid/icd-10-cm  http://hl7.org/fhir/sid/icd-9-cm  http://snomed.info/sct
Claim.Problems.Term
Domain: DiagnosisCode
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemDate') Claim.Problems.Date
diagnosis.extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension.html') Claim.Problems.OnAdmission
Domain: DiagnosisStatusOnAdmission
diagnosis.sequence Claim.Problems.Sequence
diagnosis.type Claim.Problems.Type
Domain: DiagnosisType
disposition Claim.Property('FHIRExplanationOfBenefitDisposition')
extension('http://careevolution.com/fhirextensions#properties') Claim.Properties
extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-pmt-dnl-cd-extension.html') Claim.Property('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-pmt-dnl-cd-extension.html')
extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-hha-clm-mdcr-non-pmt-rsn-cd-extension.html') Claim.NonPaymentReason
Domain: NonPaymentReason
extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-mdcr-non-pmt-rsn-cd-extension.html') Claim.NonPaymentReason
Domain: NonPaymentReason
extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension.html') Claim.NonPaymentReason
Domain: NonPaymentReason
extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-snf-clm-mdcr-non-pmt-rsn-cd-extension.html') Claim.NonPaymentReason
Domain: NonPaymentReason
facility.extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-pde-phrmcy-srvc-type-cd-extension.html') Claim.Property('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-pde-phrmcy-srvc-type-cd-extension.html')
facility.identifier Claim.Property('FacilityNpi')
identifier Claim.Identifier
Claim.AlternateIdentifier
information.category
Bindings:  valueset-claim-informationcategory
Claim.ClaimSupportingInformation.Type
Domain: SupportingInformationType
information.code Claim.ClaimSupportingInformation.Term
Domain: SupportingInformationCode
information.reason Claim.ClaimSupportingInformation.Reason
Domain: SupportingInformationReason
information.sequence Claim.ClaimSupportingInformation.Sequence
information.timing Claim.ClaimSupportingInformation.StartDate
Claim.ClaimSupportingInformation.EndDate
information.value Claim.ClaimSupportingInformation.Value
insurance.coverage Claim.InsuranceID
Claim.InsuranceIdentifier
item.category Claim.Services.RevenueCode
Domain: RevenueCode
Claim.Services.Property('IsFromFhirCategoryProperty')
item.detail.type.coding.display Medications.Comment
item.diagnosisLinkId Claim.Services.Property('FHIRDiagnosisLinkId')
item.extension('http://careevolution.com/fhirextensions#properties') Medications.Properties
item.extension('http://hl7.org/fhir/ValueSet/v3-ActInvoiceGroupCode') Claim.Services.Property('http://hl7.org/fhir/ValueSet/v3-ActInvoiceGroupCode')
item.extension('https://bluebutton.cms.gov/resources/variables/betos_cd') Claim.Services.Property('https://bluebutton.cms.gov/resources/variables/betos_cd')
item.extension('https://bluebutton.cms.gov/resources/variables/carr_line_mtus_cd') Claim.Services.Property('https://bluebutton.cms.gov/resources/variables/carr_line_mtus_cd')
item.extension('https://bluebutton.cms.gov/resources/variables/carr_line_mtus_cnt') Claim.Services.Property('https://bluebutton.cms.gov/resources/variables/carr_line_mtus_cnt')
item.extension('https://bluebutton.cms.gov/resources/variables/line_service_deductible') Claim.Services.Property('https://bluebutton.cms.gov/resources/variables/line_service_deductible')
item.location
Bindings:  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  https://rosetta.careevolution.com/UBFacilityType  http://hl7.org/fhir/v3/ActCode
Claim.Services.LocationType
Domain: ServiceLocation
item.modifier
Bindings:  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://snomed.info/sct
Claim.Services.Modifier1
Domain: BillingModifier
Claim.Services.Modifier2
Domain: BillingModifier
Claim.Services.Modifier3
Domain: BillingModifier
Claim.Services.Modifier4
Domain: BillingModifier
Claim.Services.Modifier5
Domain: BillingModifier
item.procedureLinkId Claim.Services.Property('FHIRProcedureLinkId')
item.quantity
Bindings:  http://unitsofmeasure.org
Medications.Quantity
Medications.Units
Domain: MedicationUnits
Medications.Term
Domain: MedicationType
Claim.Services.Units
item.quantity.extension('https://bluebutton.cms.gov/resources/variables/days_suply_num') Medications.DaysSupplied
item.quantity.extension('https://bluebutton.cms.gov/resources/variables/fill_num') Medications.RefillNumber
item.revenue Claim.Services.RevenueCode
Domain: RevenueCode
Claim.Services.Property('IsFromFhirCategoryProperty')
item.sequence Medications.Identifier
Medications.Sequence
Claim.Services.Sequence
item.service
Bindings:  http://hl7.org/fhir/sid/cvx  http://hl7.org/fhir/sid/ndc  http://www.nlm.nih.gov/research/umls/rxnorm  http://snomed.info/sct  http://www.ada.org/cdt  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://www.cms.gov/Medicare/Coding/ICD10  http://hl7.org/fhir/sid/icd-9-cm
Medications.Term
Domain: MedicationType
Claim.Services.ServiceCode
Domain: ServiceCode
item.serviced Medications.Date
Claim.Services.StartDate
Claim.Services.EndDate
patient Claim.PatientID
payment.amount Claim.TotalPaid
procedure.date Claim.Procedures.Date
procedure.extension('http://careevolution.com/fhirextensions#claim-procedureType') Claim.Procedures.Type
Domain: ProcedureType
procedure.procedure
Bindings:  http://www.ada.org/cdt  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://www.cms.gov/Medicare/Coding/ICD10  http://hl7.org/fhir/sid/icd-9-cm  http://snomed.info/sct
Claim.Procedures.Term
Domain: ProcedureCode
procedure.sequence Claim.Procedures.Sequence
status
Bindings:  valueset-explanationofbenefit-status
Claim.Status
Domain: ClaimStatus
text Claim.Comment
totalBenefit Claim.TotalAllowed
totalCost Claim.Property('MDCR_INSTNL_TOT_CHRG_AMT')
type
Bindings:  valueset-claim-type
Claim.ClaimType
Domain: ClaimType
Claim.BillClass
Domain: BillClass

From FHIR mappings

FHIR CareEvolution
benefitBalance.financial.used Claim.Properties
billablePeriod Claim.StartDate
Claim.EndDate
billablePeriod.extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-claim-query-cd-extension.html') Claim.Property('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-claim-query-cd-extension.html')
billablePeriod.extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension.html') Claim.Property('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-claim-query-cd-extension.html')
billablePeriod.extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-snf-claim-query-cd-extension.html') Claim.Property('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-snf-claim-query-cd-extension.html')
careTeam.provider Claim.CaregiverRelationships.CaregiverID
Claim.Services.CaregiverRelationships.CaregiverID
careTeam.role
Bindings:  valueset-claim-careteamrole
Claim.CaregiverRelationships.RelationshipType
Domain: CaregiverRelationshipType
Claim.Services.CaregiverRelationships.RelationshipType
Domain: CaregiverRelationshipType
diagnosis.diagnosis
Bindings:  http://hl7.org/fhir/sid/icd-10-cm  http://hl7.org/fhir/sid/icd-9-cm  http://snomed.info/sct
Claim.Problems.Term
Domain: DiagnosisCode
diagnosis.extension('http://careevolution.com/fhirextensions#claim-problemDate') Claim.Problems.Date
diagnosis.extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-poa-ind-sw1-extension.html') Claim.Problems.OnAdmission
Domain: DiagnosisStatusOnAdmission
diagnosis.packageCode Claim.Properties
diagnosis.sequence Claim.Problems.Sequence
diagnosis.type Claim.Problems.Type
Domain: DiagnosisType
disposition Claim.Property('FHIRExplanationOfBenefitDisposition')
extension Claim.Properties
extension('http://careevolution.com/fhirextensions#properties') Claim.Properties
extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-pmt-dnl-cd-extension.html') Claim.Property('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-carrier-carr-clm-pmt-dnl-cd-extension.html')
extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-hha-clm-mdcr-non-pmt-rsn-cd-extension.html') Claim.NonPaymentReason
Domain: NonPaymentReason
extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-inpatient-clm-mdcr-non-pmt-rsn-cd-extension.html') Claim.NonPaymentReason
Domain: NonPaymentReason
extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-outpatient-clm-mdcr-non-pmt-rsn-cd-extension.html') Claim.NonPaymentReason
Domain: NonPaymentReason
extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-snf-clm-mdcr-non-pmt-rsn-cd-extension.html') Claim.NonPaymentReason
Domain: NonPaymentReason
facility.extension Claim.Properties
facility.extension('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-pde-phrmcy-srvc-type-cd-extension.html') Claim.Property('https://bluebutton.cms.gov/assets/ig/StructureDefinition-bluebutton-pde-phrmcy-srvc-type-cd-extension.html')
facility.identifier Claim.Property('FacilityNpi')
id Claim.Identifier
identifier Claim.Identifier
Claim.AlternateIdentifier
information.category
Bindings:  valueset-claim-informationcategory
Claim.ClaimSupportingInformation.Type
Domain: SupportingInformationType
information.code Claim.ClaimSupportingInformation.Term
Domain: SupportingInformationCode
information.reason Claim.ClaimSupportingInformation.Reason
Domain: SupportingInformationReason
information.sequence Claim.ClaimSupportingInformation.Sequence
information.timing Claim.ClaimSupportingInformation.StartDate
Claim.ClaimSupportingInformation.EndDate
information.value Claim.ClaimSupportingInformation.Value
insurance.coverage Claim.InsuranceID
Claim.InsuranceIdentifier
item.adjudication Medications.AmountPaid
Medications.AmountBilled
Claim.Services.AmountPaid
Claim.Services.AmountClaimed
Claim.Services.Status
Domain: ClaimServiceStatus
item.category Claim.Services.RevenueCode
Domain: RevenueCode
Claim.Services.Property('IsFromFhirCategoryProperty')
item.detail.type.coding.display Medications.Comment
item.diagnosisLinkId Claim.Services.Property('FHIRDiagnosisLinkId')
item.extension Claim.Services.Properties
item.extension('http://careevolution.com/fhirextensions#properties') Medications.Properties
item.extension('http://hl7.org/fhir/ValueSet/v3-ActInvoiceGroupCode') Claim.Services.Property('http://hl7.org/fhir/ValueSet/v3-ActInvoiceGroupCode')
item.extension('https://bluebutton.cms.gov/resources/variables/betos_cd') Claim.Services.Property('https://bluebutton.cms.gov/resources/variables/betos_cd')
item.extension('https://bluebutton.cms.gov/resources/variables/carr_line_mtus_cd') Claim.Services.Property('https://bluebutton.cms.gov/resources/variables/carr_line_mtus_cd')
item.extension('https://bluebutton.cms.gov/resources/variables/carr_line_mtus_cnt') Claim.Services.Property('https://bluebutton.cms.gov/resources/variables/carr_line_mtus_cnt')
item.extension('https://bluebutton.cms.gov/resources/variables/line_service_deductible') Claim.Services.Property('https://bluebutton.cms.gov/resources/variables/line_service_deductible')
item.location
Bindings:  https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set  https://rosetta.careevolution.com/UBFacilityType  http://hl7.org/fhir/v3/ActCode
Claim.Services.LocationType
Domain: ServiceLocation
item.modifier
Bindings:  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://snomed.info/sct
Claim.Services.Modifier1
Domain: BillingModifier
Claim.Services.Modifier2
Domain: BillingModifier
Claim.Services.Modifier3
Domain: BillingModifier
Claim.Services.Modifier4
Domain: BillingModifier
Claim.Services.Modifier5
Domain: BillingModifier
item.procedureLinkId Claim.Services.Property('FHIRProcedureLinkId')
item.quantity
Bindings:  http://unitsofmeasure.org
Medications.Quantity
Medications.Units
Domain: MedicationUnits
Claim.Services.Units
item.quantity.extension('https://bluebutton.cms.gov/resources/variables/days_suply_num') Medications.DaysSupplied
item.quantity.extension('https://bluebutton.cms.gov/resources/variables/fill_num') Medications.RefillNumber
item.revenue Claim.Services.RevenueCode
Domain: RevenueCode
Claim.Services.Property('IsFromFhirCategoryProperty')
item.sequence Medications.Identifier
Medications.Sequence
Claim.Services.Sequence
item.service
Bindings:  http://hl7.org/fhir/sid/cvx  http://hl7.org/fhir/sid/ndc  http://www.nlm.nih.gov/research/umls/rxnorm  http://snomed.info/sct  http://www.ada.org/cdt  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://www.cms.gov/Medicare/Coding/ICD10  http://hl7.org/fhir/sid/icd-9-cm
Medications.Term
Domain: MedicationType
Claim.Services.ServiceCode
Domain: ServiceCode
item.serviced Medications.Date
Claim.Services.StartDate
Claim.Services.EndDate
patient Claim.PatientID
payment.amount Claim.TotalPaid
procedure.date Claim.Procedures.Date
procedure.extension('http://careevolution.com/fhirextensions#claim-procedureType') Claim.Procedures.Type
Domain: ProcedureType
procedure.procedure
Bindings:  http://www.ada.org/cdt  https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets  http://www.cms.gov/Medicare/Coding/ICD10  http://hl7.org/fhir/sid/icd-9-cm  http://snomed.info/sct
Claim.Procedures.Term
Domain: ProcedureCode
procedure.sequence Claim.Procedures.Sequence
status
Bindings:  valueset-explanationofbenefit-status
Claim.Status
Domain: ClaimStatus
text Claim.Comment
totalBenefit Claim.TotalAllowed
totalCost Claim.Property('MDCR_INSTNL_TOT_CHRG_AMT')
type
Bindings:  valueset-claim-type
Claim.ClaimType
Domain: ClaimType
Claim.BillClass
Domain: BillClass