BFD-4784: Create way to generate EOB-Pharmacy data json files for model-idr by marshallweekley-eng · Pull Request #3239 · CMSgov/beneficiary-fhir-data

marshallweekley-eng · 2026-08-04T20:11:08Z

JIRA Ticket:
BFD-4784

What Does This PR Do?

Create way to generate EOB-Pharmacy data json files for model-idr.

This is written to be able to be built upon for other eob types

What Should Reviewers Watch For?

That the sample output is what we are looking for.

If you're reviewing this PR, please check for these things in particular:

Data mapping and that data is coming from the correct files.

What Security Implications Does This PR Have?

Please indicate if this PR does any of the following:

Adds any new software dependencies
Modifies any security controls
Adds new transmission or storage of data
Any other changes that could possibly affect security?
I have considered the above security implications as it relates to this PR. (If one or more of the above apply, it cannot be merged without the ISSO or team security engineer's (@sb-benohe) approval.)
I have created tests to sufficiently ensure the reliability of my code, if applicable. If this is a modification to an existing piece of code, I have audited the associated tests to ensure everything works as expected.

Validation

It is being compared against the existing sample file to see that it has all data nodes.

Example output

{
  "resourceType": "ExplanationOfBenefit-Pharmacy",
  "id": "5003182605428",
  "lastUpdated": "2025-11-17 14:13:59.002053",
  "CLM_FINL_ACTN_IND": "Y",
  "CLM_SRC_ID": "20000",
  "BENE_SK": "-683399246",
  "CLM_TYPE_CD": 2,
  "CLM_UNIQ_ID": "-5003182605428",
  "CLM_CNTL_NUM": "-87030670488496VTA",
  "CLM_ORIG_CNTL_NUM": "-08471235414105FMQ",
  "CLM_FROM_DT": "2023-12-20",
  "CLM_THRU_DT": "2024-01-19",
  "CLM_EFCTV_DT": "2026-08-04",
  "CLM_SRVC_PRVDR_GNRC_ID_NUM": "1656158338",
  "CLM_PD_DT": "2023-12-31",
  "PRVDR_PRSCRBNG_PRVDR_NPI_NUM": "2056702345",
  "CLM_PRSBNG_PRVDR_GNRC_ID_NUM": "2056702345",
  "PRVDR_PRSBNG_ID_QLFYR_CD": "08",
  "PRVDR_LAST_NAME": "",
  "CNTRCT_PBP_NAME": "Happy Heart",
  "CLM_BENE_PMT_AMT": "28.37",
  "CLM_OTHR_TP_PD_AMT": "776.75",
  "META_SRC_SK": "7",
  "PRVDR_SRVC_ID_QLFYR_CD": "08",
  "supportingInfoComponents": [],
  "lineItemComponents": [
    {
      "CLM_LINE_NUM": "1",
      "CLM_LINE_FROM_DT": "2023-12-20",
      "CLM_LINE_NDC_CD": "00338011704",
      "CLM_LINE_NDC_QTY": "8",
      "CLM_LINE_NDC_QTY_QLFYR_CD": "ML",
      "CLM_LINE_CVRD_PD_AMT": "457378.85",
      "CLM_LINE_GRS_ABOVE_THRSHLD_AMT": "379162.84",
      "CLM_LINE_GRS_BLW_THRSHLD_AMT": "723008.55",
      "CLM_LINE_LIS_AMT": "347272.83",
      "CLM_LINE_TROOP_TOT_AMT": "349911.82",
      "CLM_LINE_PLRO_AMT": "76176.32",
      "CLM_RPTD_MFTR_DSCNT_AMT": "208343.02",
      "CLM_LINE_INGRDNT_CST_AMT": "293667.21",
      "CLM_LINE_SRVC_CST_AMT": "191300.47",
      "CLM_LINE_SLS_TAX_AMT": "745040.33",
      "CLM_LINE_VCCN_ADMIN_FEE_AMT": "806157.04",
      "CLM_PRCNG_EXCPTN_CD": "M",
      "CLM_LINE_BENE_PMT_AMT": "4.66",
      "CLM_CMS_CALCD_MFTR_DSCNT_AMT": "838.25",
      "CLM_LINE_GRS_CVRD_CST_TOT_AMT": "",
      "CLM_LINE_REBT_PASSTHRU_POS_AMT": "843.63",
      "CLM_PHRMCY_PRICE_DSCNT_AT_POS_AMT": "129.77",
      "CLM_LINE_OTHR_TP_PD_AMT": "500.02",
      "CLM_LINE_NCVRD_PD_AMT": "763103.57",
      "CLM_LINE_RPTD_GAP_DSCNT_AMT": "295541.44",
      "CLM_LINE_AUTHRZD_FILL_NUM": "0",
      "CLM_PHRMCY_SRVC_TYPE_CD": "01",
      "CLM_LINE_RX_ORGN_CD": "3",
      "CLM_BRND_GNRC_CD": "B",
      "CLM_PTNT_RSDNC_CD": "13",
      "CLM_LTC_DSPNSNG_MTHD_CD": "18",
      "CLM_CMPND_CD": "2",
      "CLM_LINE_DAYS_SUPLY_QTY": "6",
      "CLM_LINE_RX_FILL_NUM": "6",
      "CLM_DAW_PROD_SLCTN_CD": "0",
      "CLM_DRUG_CVRG_STUS_CD": "O",
      "CLM_CTSTRPHC_CVRG_IND_CD": "A",
      "CLM_LINE_RX_NUM": "22120.27",
      "CLM_DSPNSNG_STUS_CD": "C"
    }
  ],
  "CLM_CMS_PROC_DT": "2024-01-19",
  "CLM_IDR_LD_DT ": "2024-09-01",
  "CLM_ADJSTMT_TYPE_CD": "2",
  "CLM_SBMT_FRMT_CD": "A",
  "CLM_SBMTR_CNTRCT_NUM": "Z0005",
  "CLM_SBMTR_CNTRCT_PBP_NUM": "004",
  "CLM_DT_SGNTR_SK": "-287553384478"
}

Produced

{
  "resourceType" : "ExplanationOfBenefit",
  "meta" : {
    "lastUpdated" : "2026-01-01T03:02:28.000000Z",
    "source" : "NCH",
    "profile" : ["http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy|2.2.0",
    "https://bluebutton.cms.gov/fhir/StructureDefinition/CMS-ExplanationOfBenefit-Pharmacy"],
    "tag" : [{
      "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/System-Type",
      "code" : "NationalClaimsHistory"
    }]
  },
  "contained" : [{
    "resourceType" : "Organization",
    "id" : "insurer-org",
    "meta" : {
      "profile" : ["http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization|2.2.0",
      "http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization|7.0.0"]
    },
    "active" : true,
    "name" : "Happy Heart"
  },
  {
    "resourceType" : "Organization",
    "id" : "BILLING-ID",
    "identifier" : [{
      "type" : {
        "coding" : [{
          "system" : "http://bluebutton.cms.gov/fhir/CodeSystem/PRVDR-ID-QLFYR-CD",
          "code" : "08",
          "display" : "State License Number"
        }]
      },
      "system" : "http://bluebutton.cms.gov/fhir/identifiers/GenericIdNum",
      "value" : "1656158338"
    }],
    "active" : true,
    "name" : "N/A"
  },
  {
    "resourceType" : "Organization",
    "id" : "BILLING-ID",
    "identifier" : [{
      "type" : {
        "coding" : [{
          "system" : "http://bluebutton.cms.gov/fhir/CodeSystem/PRVDR-ID-QLFYR-CD",
          "code" : "08",
          "display" : "State License Number"
        }]
      },
      "system" : "http://bluebutton.cms.gov/fhir/identifiers/GenericIdNum",
      "value" : "2056702345"
    }],
    "active" : true
  }],
  "identifier" : [{
    "type" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
        "code" : "uc",
        "display" : "Unique Claim ID"
      }]
    },
    "value" : "-5003182605428"
  },
  {
    "system" : "https://bluebutton.cms.gov/identifiers/CLM-CNTL-NUM",
    "value" : "-08471235414105FMQ"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "pharmacy"
    },
    {
      "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-TYPE-CD",
      "code" : "2",
      "display" : "MEDICARE PART D ADJUSTED CLAIM"
    },
    {
      "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/EOB-TYPE",
      "code" : "PDE"
    }]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/-683399246"
  },
  "billablePeriod" : {
    "start" : "2023-12-20",
    "end" : "2024-01-19"
  },
  "created" : "2026-08-04",
  "insurer" : {
    "reference" : "#insurer-org"
  },
  "provider" : {
    "reference" : "#BILLING-ID"
  },
  "outcome" : "complete",
  "supportingInfo" : [{
    "sequence" : 1,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_ADJSTMT_TYPE_CD",
        "display" : "Claim Adjustment Type Code"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-ADJSTMT-TYPE-CD",
        "code" : "2",
        "display" : "REPLACEMENT"
      }]
    }
  },
  {
    "sequence" : 2,
    "category" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
        "code" : "brandgenericindicator"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/NCPDPBrandGenericIndicator",
        "code" : "B"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-BRND-GNRC-CD",
        "code" : "B",
        "display" : "Brand"
      }]
    }
  },
  {
    "sequence" : 3,
    "category" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
        "code" : "compoundcode"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/NCPDPCompoundCode",
        "code" : "2"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-CMPND-CD",
        "code" : "2",
        "display" : "Compound"
      }]
    }
  },
  {
    "sequence" : 4,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_CMS_PROC_DT",
        "display" : "FI Claim Process Date"
      }]
    },
    "timingDate" : "2024-01-19"
  },
  {
    "sequence" : 5,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_CTSTRPHC_CVRG_IND_CD",
        "display" : "Catastrophic Coverage Code"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-CTSTRPHC-CVRG-IND-CD",
        "code" : "A",
        "display" : "Attachment point met on this event"
      }]
    }
  },
  {
    "sequence" : 6,
    "category" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
        "code" : "dawcode"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/NCPDPDispensedAsWrittenOrProductSelectionCode",
        "code" : "0"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-DAW-PROD-SLCTN-CD",
        "code" : "0",
        "display" : "No product selection indicated"
      }]
    }
  },
  {
    "sequence" : 7,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_DRUG_CVRG_STUS_CD",
        "display" : "Drug Coverage Status Code"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-DRUG-CVRG-STUS-CD",
        "code" : "O",
        "display" : "Over-the-counter drugs"
      }]
    }
  },
  {
    "sequence" : 8,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_DSPNSNG_STUS_CD",
        "display" : "Claim Dispensing Status Code"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-DSPNSNG-STUS-CD",
        "code" : "C",
        "display" : "Completely filled"
      }]
    }
  },
  {
    "sequence" : 9,
    "category" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
        "code" : "refillsauthorized"
      }]
    },
    "valueQuantity" : {
      "value" : 0,
      "unit" : "refills"
    }
  },
  {
    "sequence" : 10,
    "category" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
        "code" : "dayssupply"
      }]
    },
    "valueQuantity" : {
      "value" : 6,
      "unit" : "days"
    }
  },
  {
    "sequence" : 11,
    "category" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
        "code" : "refillnum"
      }]
    },
    "valueQuantity" : {
      "value" : 6,
      "unit" : "fill"
    }
  },
  {
    "sequence" : 12,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_LINE_RX_NUM",
        "display" : "Claim Line Prescription Service Reference Number"
      }]
    },
    "valueString" : "22120.27"
  },
  {
    "sequence" : 13,
    "category" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType",
        "code" : "rxorigincode"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/NCPDPPrescriptionOriginCode",
        "code" : "3"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-LINE-RX-ORGN-CD",
        "code" : "3",
        "display" : "Electronic"
      }]
    }
  },
  {
    "sequence" : 14,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_LTC_DSPNSNG_MTHD_CD",
        "display" : "Submission Clarification Code"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-LTC-DSPNSNG-MTHD-CD",
        "code" : "18",
        "display" : "LTC patient admit/readmission indicator. This status required new dispensing of medication."
      }]
    }
  },
  {
    "sequence" : 15,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_PHRMCY_SRVC_TYPE_CD",
        "display" : "Pharmacy Service Type Code"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-PHRMCY-SRVC-TYPE-CD",
        "code" : "01",
        "display" : "Community/retail pharmacy"
      }]
    }
  },
  {
    "sequence" : 16,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_PTNT_RSDNC_CD",
        "display" : "Patient Residence Code"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-PTNT-RSDNC-CD",
        "code" : "13",
        "display" : "Comprehensive Inpatient Rehabilitation Facility"
      }]
    }
  },
  {
    "sequence" : 17,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_SBMTR_CNTRCT_NUM",
        "display" : "Submitter Contract Number"
      }]
    },
    "valueString" : "Z0005"
  },
  {
    "sequence" : 18,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_SBMTR_CNTRCT_PBP_NUM",
        "display" : "Submitter Contract PBP Number"
      }]
    },
    "valueString" : "004"
  },
  {
    "sequence" : 19,
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
        "code" : "info",
        "display" : "Information"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Supporting-Information",
        "code" : "CLM_SBMT_FRMT_CD",
        "display" : "Claim Submission Format Code"
      }]
    },
    "code" : {
      "coding" : [{
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/CLM-SBMT-FRMT-CD",
        "code" : "A",
        "display" : "MEDICAID SUBROGATION CLAIM"
      }]
    }
  }],
  "insurance" : [{
    "focal" : true,
    "coverage" : {
      "display" : "Part D"
    }
  }],
  "item" : [{
    "sequence" : 1,
    "servicedDate" : "2023-12-20",
    "adjudication" : [{
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "benefit",
          "display" : "Benefit Amount"
        },
        {
          "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
          "code" : "CLM_LINE_CVRD_PD_AMT",
          "display" : "Payment Amount"
        }]
      },
      "amount" : {
        "value" : 457378.85,
        "currency" : "USD"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
          "code" : "paidbypatient",
          "display" : "Paid by patient"
        },
        {
          "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
          "code" : "CLM_LINE_BENE_PMT_AMT",
          "display" : "Line Paid By Beneficiary Amount"
        }]
      },
      "amount" : {
        "value" : 4.66,
        "currency" : "USD"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
          "code" : "CLM_LINE_GRS_ABOVE_THRSHLD_AMT",
          "display" : "Gross Drug Cost Above Out Of Pocket Threshold"
        }]
      },
      "amount" : {
        "value" : 379162.84,
        "currency" : "USD"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
          "code" : "CLM_LINE_GRS_BLW_THRSHLD_AMT",
          "display" : "Gross Drug Cost Below Out Of Pocket Threshold"
        }]
      },
      "amount" : {
        "value" : 723008.55,
        "currency" : "USD"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
          "code" : "CLM_LINE_LIS_AMT",
          "display" : "Low Income Cost Sharing Subsidy Amount"
        }]
      },
      "amount" : {
        "value" : 347272.83,
        "currency" : "USD"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
          "code" : "CLM_LINE_PLRO_AMT",
          "display" : "Patient Liability Reduction Other Paid Amount"
        }]
      },
      "amount" : {
        "value" : 76176.32,
        "currency" : "USD"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
          "code" : "CLM_LINE_RPTD_GAP_DSCNT_AMT",
          "display" : "Claim Line Reported Gap Discount Amount"
        }]
      },
      "amount" : {
        "value" : 295541.44,
        "currency" : "USD"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
          "code" : "submitted",
          "display" : "Submitted Amount"
        },
        {
          "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
          "code" : "TOT_RX_CST_AMT",
          "display" : "Total RX Cost Amount"
        }]
      },
      "amount" : {
        "value" : 2036165.05,
        "currency" : "USD"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
          "code" : "CLM_LINE_NCVRD_PD_AMT",
          "display" : "Amount Paid for Noncovered Product or Service"
        }]
      },
      "amount" : {
        "value" : 763103.57,
        "currency" : "USD"
      }
    },
    {
      "category" : {
        "coding" : [{
          "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
          "code" : "CLM_LINE_OTHR_TP_PD_AMT",
          "display" : "Other Third Party Paid Amount"
        }]
      },
      "amount" : {
        "value" : 500.02,
        "currency" : "USD"
      }
    }]
  }],
  "adjudication" : [{
    "category" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator",
        "code" : "benefitpaymentstatus",
        "display" : "Benefit Payment Status"
      }]
    },
    "reason" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus",
        "code" : "other",
        "display" : "Other"
      }]
    }
  }],
  "total" : [{
    "category" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
        "code" : "paidbypatient",
        "display" : "Paid by patient"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
        "code" : "CLM_BENE_PMT_AMT",
        "display" : "Paid By Beneficiary Amount"
      }]
    },
    "amount" : {
      "value" : 28.37,
      "currency" : "USD"
    }
  },
  {
    "category" : {
      "coding" : [{
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
        "code" : "CLM_OTHR_TP_PD_AMT",
        "display" : "Other Third Party Payer Paid Amount"
      }]
    },
    "amount" : {
      "value" : 776.75,
      "currency" : "USD"
    }
  },
  {
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
        "code" : "submitted",
        "display" : "Submitted Amount"
      },
      {
        "system" : "https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication",
        "code" : "TOT_RX_CST_AMT",
        "display" : "Total RX Cost Amount"
      }]
    },
    "amount" : {
      "value" : 2036165.05,
      "currency" : "USD"
    }
  }],
  "payment" : {
    "date" : "2023-12-31"
  }
}

alex-dzeda · 2026-08-05T13:33:53Z

Adding specific comments, but can you also post the output of running the conformance testing against the generated input? Anything of note? (you can grab the snippet in ./compile-all-resources.sh for pharmacy, just make sure you run sushi, too, if you're running it in isolation).

Co-authored-by: aschey-forpeople <162160982+aschey-forpeople@users.noreply.github.com>

Create util method for str extract EOB Type AutoDetection

marshallweekley-eng · 2026-08-05T19:28:00Z

Adding specific comments, but can you also post the output of running the conformance testing against the generated input? Anything of note? (you can grab the snippet in ./compile-all-resources.sh for pharmacy, just make sure you run sushi, too, if you're running it in isolation).

I added the sushi output.

Co-authored-by: aschey-forpeople <162160982+aschey-forpeople@users.noreply.github.com>

bfd-sast · 2026-08-07T14:14:07Z

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marshallweekley-eng added 3 commits August 4, 2026 15:06

Create generate_eob_sample.py

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Create util method for str extract EOB Type AutoDetection

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update parm name for posix

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BFD-4784: Create way to generate EOB-Pharmacy data json files for model-idr - #3239

BFD-4784: Create way to generate EOB-Pharmacy data json files for model-idr#3239
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