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