Stream: CARIN IG for Blue Button®
Topic: EOB Inclusion Based on Paper or Electronic EOB
Courtney Bland (Aug 31 2020 at 16:59):
Hello, I was hoping someone could settle a debate for me. Should a claim only be returned in an EOB profile response if a paper or electronic EOB has been produced? Thank you for your time.
Karl M. Davis (Aug 31 2020 at 17:05):
I think your next question is more on-the-nose: if the claim has been adjudicated, you should probably include it.
(I'm approaching this more from the perspective of the end-user, who would certainly prefer to get the information as soon as possible.)
Jason Teeple (Sep 02 2020 at 16:48):
Claim isn't a profiled resource and not required as part of the IG. It is not to say, you couldn't provide a claim resource. You will need to either adopt a profiled version (outside of this IG) or profile the resource yourself.
Courtney Bland (Sep 10 2020 at 15:46):
Jason Teeple said:
Claim isn't a profiled resource and not required as part of the IG. It is not to say, you couldn't provide a claim resource. You will need to either adopt a profiled version (outside of this IG) or profile the resource yourself.
Thank you for your feedback. It is very much appreciated. I'm just concerned that I am not interpreting your answer correctly or I am not stating my question clearly. We populate the CARIN Explanation of Benefit profiles using adjudicated claim data. We can provide this data prior to an EOB being produced for that claim, almost immediately after adjudication. Someone indicated, though, that we may need to wait until after the EOB itself has been produced. I'm not referring to the creation of a claim profile.
Last updated: Apr 12 2022 at 19:14 UTC
