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FHIR Resources supported for “Health Plans”

Administrative Health Plan Data (such as eligibility, enrollment, adjudicated claims, providers, and organizations)

FHIR Resources supported for “Health Plans” under the CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) implementation guide (IG version 1.2.0, FHIR 4.0.1). For the CARIN BB implementation, the following resources are supported:
1) C4BB Patient (based on Patient R4)
2) C4BB Coverage (based on Coverage R4)
3) C4BB ExplanationOfBenefit (based on Claim R4 and ClaimResponse R4)
4) C4BB Practitioner (based on Coverage R4)
5) C4BB Organization (based on Coverage R4)

Supplemental Clinical Data from Healthcare Providers maintained by Health Plans

In addition, for Health Plans that also maintain supplemental clinical data from Healthcare Providers that meet the criteria of U.S. Core Data for Interoperability (USCDI) v1 the following FHIR resources are supported under the US Core Implementation Guide (v4.0.0: STU4) based on FHIR R4:
Note that clinical data maintained by payers can vary, and only data that meets the criteria of USCDI is required.