Test Sandbox APIs
API Reference
Capability Statement
Explanation of Benefits
The Explanation of Benefit (EOB) API enables Humana members to share written explanation of benefits with third party applications. Explanation of benefits include the payments Humana has made on behalf of a member and a description of the healthcare services provided to the member. This API conforms to the R4 FHIR standard and the CARIN Blue Button FHIR STU1 Implementation Guide.
URL
Headers
| ACCEPT | application/json |
| AUTHORIZATION | Bearer {ACCESS_TOKEN} |
Sample Request
curl -X GET \
https://sandbox-fhir.humana.com/api/ExplanationOfBenefit \
-H 'Accept: application/json' \
-H 'Authorization: Bearer {your access token}' \curl -X GET \
https://fhir.humana.com/api/ExplanationOfBenefit \
-H 'Accept: application/json' \
-H 'Authorization: Bearer {your access token}' \Sample Response
{
"resourceType": "Bundle",
"type": "searchset",
"timestamp": "2025-01-15T05:16:02.635+00:00",
"meta": {
"lastUpdated": "2025-01-15T05:16:02.635+00:00",
"versionId": "edc04c4b-ea57-4313-94ef-bf44b138301b"
},
"entry": [
{
"fullUrl": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit/15ff71886c0732526d758d87857f739868ef8a3259319128b993c9364f51b82f",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "15ff71886c0732526d758d87857f739868ef8a3259319128b993c9364f51b82f",
"meta": {
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"versionId": "1afcf532-dd09-42a2-a7ee-d49ef6c4e8e7",
"lastUpdated": "2025-01-15T03:56:46.371+00:00"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code": "uc"
}
]
},
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "244956709341"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
}
],
"text": "Pharmacy"
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"billablePeriod": {
"start": "2024-04-04"
},
"created": "2024-04-04",
"insurer": {
"reference": "Organization/67c29814ee1eb20b1be2c2c692cfdd2cfb84e919a867998eccd1762b7b785780",
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1841422979"
},
"display": "SHILPA ARUN MALEKAR"
},
"prescription": {
"identifier": {
"system": "http://hl7.org/fhir/sid/ndc",
"value": "00006027782"
},
"display": "Januvia 100 mg tablet"
},
"payee": {
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/payeetype",
"code": "provider",
"display": "Provider"
}
]
},
"party": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1063675684"
},
"display": "HUMANA PHARMACY, INC."
}
},
"facility": {
"display": "9843 WINDISCH ROAD, WEST CHESTER, OH, 45069"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H71498680"
}
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "000665036",
"display": "Januvia 100 mg tablet"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "00006027782",
"display": "Januvia 100 mg tablet"
}
]
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 2062.8,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidbypatient"
}
],
"text": "Paid by patient"
},
"amount": {
"value": 1654.54,
"currency": "USD"
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "CoPay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 1654.84,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "PAID"
}
]
},
"date": "2024-04-04",
"amount": {
"value": 1654.84,
"currency": "USD"
}
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit/b587139d9106c33f1c2648b8df295e4b9d9f98b03738b98f64e904df3f02165b",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "b587139d9106c33f1c2648b8df295e4b9d9f98b03738b98f64e904df3f02165b",
"meta": {
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"versionId": "65deee4b-eb60-4184-a05f-f95be8e949fc",
"lastUpdated": "2025-01-15T03:56:46.980+00:00"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code": "uc"
}
]
},
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "244956707751"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
}
],
"text": "Pharmacy"
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"billablePeriod": {
"start": "2024-04-04"
},
"created": "2024-04-04",
"insurer": {
"reference": "Organization/67c29814ee1eb20b1be2c2c692cfdd2cfb84e919a867998eccd1762b7b785780",
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "12121212"
},
"display": "eee ee ggg"
},
"prescription": {
"identifier": {
"system": "http://hl7.org/fhir/sid/ndc",
"value": "64980027903"
},
"display": "glipizide ER 2.5 mg tablet, extended release 24 hr"
},
"payee": {
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/payeetype",
"code": "provider",
"display": "Provider"
}
]
},
"party": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1063675684"
},
"display": "HUMANA PHARMACY, INC."
}
},
"facility": {
"display": "9843 WINDISCH ROAD, WEST CHESTER, OH, 45069"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H714922230"
}
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "000310489",
"display": "glipizide ER 2.5 mg tablet, extended release 24 hr"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "64980027903",
"display": "glipizide ER 2.5 mg tablet, extended release 24 hr"
}
]
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 73.8,
"currency": "USD"
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "CoPay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 0,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "PAID"
}
]
},
"date": "2024-04-04",
"amount": {
"value": 0,
"currency": "USD"
}
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit/325851594eecde9794cff556d61165f8a6b6d61b1762d5bd21e64d2b5e4324e5",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "325851594eecde9794cff556d61165f8a6b6d61b1762d5bd21e64d2b5e4324e5",
"meta": {
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"versionId": "4234568d-1ae8-475c-ae77-d40132b37810",
"lastUpdated": "2025-01-15T03:56:47.320+00:00"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code": "uc"
}
]
},
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "445722757222"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
}
],
"text": "Pharmacy"
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"billablePeriod": {
"start": "2024-06-20"
},
"created": "2024-06-20",
"insurer": {
"reference": "Organization/67c29814ee1eb20b1be2c2c692cfdd2cfb84e919a867998eccd1762b7b785780",
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1841422979"
},
"display": "SHILPA ARUN MALEKAR"
},
"prescription": {
"identifier": {
"system": "http://hl7.org/fhir/sid/ndc",
"value": "81603062510"
},
"display": "DropSafe Alcohol Prep Pads"
},
"payee": {
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/payeetype",
"code": "provider",
"display": "Provider"
}
]
},
"party": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1063675333"
},
"display": "HUMANA PHARMACY, INC."
}
},
"facility": {
"display": "9843 WINDISCH ROAD, WEST CHESTER, OH, 45069"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H71433680"
}
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "000797544",
"display": "DropSafe Alcohol Prep Pads"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "81603062533",
"display": "DropSafe Alcohol Prep Pads"
}
]
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 5,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidbypatient"
}
],
"text": "Paid by patient"
},
"amount": {
"value": 1.32,
"currency": "USD"
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "CoPay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 1.62,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "PAID"
}
]
},
"date": "2024-06-20",
"amount": {
"value": 1.62,
"currency": "USD"
}
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit/f9f0c0599f7ccc173a610d6d381d148e83a9875e3dc84d7d948220c034401af3",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "f9f0c0599f7ccc173a610d6d381d148e83a9875e3dc84d7d948220c034401af3",
"meta": {
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"versionId": "8e3217fe-cf58-495d-94d9-2fa42f5f4cf1",
"lastUpdated": "2025-01-15T03:56:47.624+00:00"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code": "uc"
}
]
},
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "445722755911"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy"
}
],
"text": "Pharmacy"
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"billablePeriod": {
"start": "2024-06-20"
},
"created": "2024-06-20",
"insurer": {
"reference": "Organization/67c29814ee1eb20b1be2c2c692cfdd2cfb84e919a867998eccd1762b7b785780",
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1841422979"
},
"display": "SHILPA ARUN MALEKAR"
},
"prescription": {
"identifier": {
"system": "http://hl7.org/fhir/sid/ndc",
"value": "56151146404"
},
"display": "True Metrix Glucose Test Strip"
},
"payee": {
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/payeetype",
"code": "provider",
"display": "Provider"
}
]
},
"party": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1063675684"
},
"display": "HUMANA PHARMACY, INC."
}
},
"facility": {
"display": "9843 WINDISCH ROAD, WEST CHESTER, OH, 45069"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H71498222"
}
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "000000000",
"display": "True Metrix Glucose Test Strip"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "56151146404",
"display": "True Metrix Glucose Test Strip"
}
]
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 63,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidbypatient"
}
],
"text": "Paid by patient"
},
"amount": {
"value": 16.64,
"currency": "USD"
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "CoPay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 17.8,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "PAID"
}
]
},
"date": "2024-06-20",
"amount": {
"value": 17.8,
"currency": "USD"
}
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit/74ea9c5b19d20b327db229c25c4c2ea18914f679c1a46b97b4cb88b9a7a667f5",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "74ea9c5b19d20b327db229c25c4c2ea18914f679c1a46b97b4cb88b9a7a667f5",
"meta": {
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"versionId": "3f2f9645-c110-4e97-8c0c-0f88fd1bb813",
"lastUpdated": "2025-01-15T03:56:47.771+00:00"
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"display": "HUMANA PHARMACY, INC."
}
},
"facility": {
"display": "9843 WINDISCH ROAD, WEST CHESTER, OH, 45069"
},
"outcome": "complete",
"insurance": [
{
"focal": true,
"coverage": {
"identifier": {
"system": "https://fhir.humana.com/documentation/glossary/memberIdBase",
"value": "H71498680"
}
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/ex-USCLS",
"code": "000979485",
"display": "losartan 25 mg tablet"
},
{
"system": "https://open.fda.gov/apis/drug/ndc",
"code": "43547036011",
"display": "losartan 25 mg tablet"
}
]
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 151.2,
"currency": "USD"
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "CoPay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 0,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "PAID"
}
]
},
"date": "2024-04-04",
"amount": {
"value": 0,
"currency": "USD"
}
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit/99666734ff0c3e1ce46ba966cb8dfb9a890d12d410413874d1871abacf435069",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "ExplanationOfBenefit",
"id": "99666734ff0c3e1ce46ba966cb8dfb9a890d12d410413874d1871abacf435069",
"meta": {
"source": "https://fhir.humana.com/documentation/glossary/HumanaDataSource",
"versionId": "ffc19656-18c3-4979-bb1e-688d9506445d",
"lastUpdated": "2025-01-15T03:56:49.230+00:00"
},
"identifier": [
{
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
"code": "uc"
}
]
},
"system": "https://fhir.humana.com/documentation/glossary/claim_id",
"value": "202308176504109"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "oral"
}
]
},
"use": "claim",
"patient": {
"reference": "Patient/5a357166754b59777137634248494434654c336d68773d3d"
},
"billablePeriod": {
"start": "2023-08-09",
"end": "2023-08-09"
},
"created": "2023-08-17",
"insurer": {
"reference": "Organization/67c29814ee1eb20b1be2c2c692cfdd2cfb84e919a867998eccd1762b7b785780",
"display": "Humana"
},
"provider": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1144874470"
}
},
"outcome": "complete",
"procedure": [
{
"sequence": 1,
"date": "2023-08-09",
"procedureCodeableConcept": {
"coding": [
{
"system": "https://www.ada.org/en/publications/cdt",
"code": "D5211",
"display": "MAXILLARY PARTIAL DENTURE - RESIN BASE"
}
]
}
},
{
"sequence": 2,
"date": "2023-08-09",
"procedureCodeableConcept": {
"coding": [
{
"system": "https://www.ada.org/en/publications/cdt",
"code": "D5212",
"display": "MANDIBULAR PARTIAL DENTURE - RESIN BASE"
}
]
}
}
],
"insurance": [
{
"focal": true,
"coverage": {
"reference": "Coverage/c9b2df7d632d6173bb611a6057b45a2a1b04015caa24f7d43326073669768770"
}
}
],
"item": [
{
"sequence": 1,
"productOrService": {
"coding": [
{
"system": "http://www.ada.org/cdt",
"code": "D5211",
"display": "MAXILLARY PARTIAL DENTURE - RESIN BASE"
}
]
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "memberliability"
}
],
"text": "Member liability"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 1947,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
],
"text": "Eligible Amount"
},
"amount": {
"value": 646,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "Copay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 646,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "noncovered"
}
],
"text": "Noncovered"
},
"amount": {
"value": 0,
"currency": "USD"
}
}
]
},
{
"sequence": 2,
"productOrService": {
"coding": [
{
"system": "http://www.ada.org/cdt",
"code": "D5212",
"display": "MANDIBULAR PARTIAL DENTURE - RESIN BASE"
}
]
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "memberliability"
}
],
"text": "Member liability"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 1947,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
],
"text": "Eligible Amount"
},
"amount": {
"value": 683,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "Copay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 683,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "noncovered"
}
],
"text": "Noncovered"
},
"amount": {
"value": 0,
"currency": "USD"
}
}
]
}
],
"total": [
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "submitted"
}
],
"text": "Submitted Amount"
},
"amount": {
"value": 3894,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "eligible"
}
],
"text": "Eligible Amount"
},
"amount": {
"value": 1329,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "deductible"
}
],
"text": "Deductible"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "coinsurance"
}
],
"text": "Co-insurance"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/adjudication",
"code": "copay"
}
],
"text": "CoPay"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "paidtoprovider"
}
],
"text": "Paid to provider"
},
"amount": {
"value": 1329,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "memberliability"
}
],
"text": "Member liability"
},
"amount": {
"value": 0,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudication",
"code": "noncovered"
}
],
"text": "Noncovered"
},
"amount": {
"value": 0,
"currency": "USD"
}
}
],
"payment": {
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode",
"code": "paid",
"display": "Paid"
}
]
},
"date": "2023-08-21",
"amount": {
"value": 1329,
"currency": "USD"
}
}
}
}
],
"total": 55,
"link": [
{
"relation": "self",
"url": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit?patient=5a357166754b59777137634248494434654c336d68773d3d&_total=accurate&_count=10&_skip=0"
},
{
"relation": "next",
"url": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit?patient=5a357166754b59777137634248494434654c336d68773d3d&_total=accurate&_count=10&_skip=10"
},
{
"relation": "last",
"url": "https://sandbox-fhir.humana.com/api/ExplanationOfBenefit?patient=5a357166754b59777137634248494434654c336d68773d3d&_total=accurate&_count=10&_skip=50"
}
],
"id": "78ede5bf-182d-4e31-8149-40514b4fdf8f"
}Explanation of Benefit: Provenance
The Explanation of Benefit (EOB) API with Provenance enables Humana members to share written explanation of benefits along with provenance details with third party applications. Explanation of Benefit Provenance provides the source and date/time of receiving Explanation of Benefit data of a member. Provenance conforms to the R4 FHIR standard and the US CORE FHIR STU 3.1.0 Implementation Guide.
URL
https://sandbox-fhir.humana.com/api/ExplanationOfBenefit?_id=d20835f60c0b44fc5859449c116999ab131ef126e52fa014097ac9ef70c40e53&_revinclude=Provenance:target
Headers
| ACCEPT | application/json |
| AUTHORIZATION | Bearer {ACCESS_TOKEN} |
Sample Request
curl -X GET \
https://sandbox-fhir.humana.com/api/ExplanationOfBenefit?_id=d20835f60c0b44fc5859449c116999ab131ef126e52fa014097ac9ef70c40e53&_revinclude=Provenance:target \
-H 'Accept: application/json' \
-H 'Authorization: Bearer {your access token}' \curl -X GET \
https://fhir.humana.com/api/ExplanationOfBenefit?_id=d20835f60c0b44fc5859449c116999ab131ef126e52fa014097ac9ef70c40e53&_revinclude=Provenance:target \
-H 'Accept: application/json' \
-H 'Authorization: Bearer {your access token}' \Sample Response
{
"resourceType": "Bundle",
"type": "searchset",
"timestamp": "2025-05-22T10:26:30.676+00:00",
"meta": {
"lastUpdated": "2025-05-22T10:26:30.676+00:00",
"versionId": "9eeefefa-3597-4cf8-8633-0be0636193ee"
},
"entry": [
{
"fullUrl": "https://sandbox-fhir.humana.com/api/Provenance/30a7ed9af3b6054869f7d783f909b03b7a94fea14db2f17b4f1608b518949ff7",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "Provenance",
"id": "30a7ed9af3b6054869f7d783f909b03b7a94fea14db2f17b4f1608b518949ff7",
"target": [
{
"reference": "ExplanationOfBenefit/f74fce38c6c35d919c136755906cdf918945f1c76b0a399da8d0a3914695d58f"
}
],
"recorded": "2024-11-20T00:00:00+00:00",
"agent": [
{
"who": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1518487784"
},
"display": "BAO TRUONG"
}
}
],
"meta": {
"versionId": "436cc140-d356-4ae1-b0db-0f95160f0057",
"lastUpdated": "2025-04-30T14:45:58.601+00:00"
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/Provenance/90e975c4fd549a14a5cd4c709e094d7a7c8d0ec44d605dc3f69cc707b257d2fe",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "Provenance",
"id": "90e975c4fd549a14a5cd4c709e094d7a7c8d0ec44d605dc3f69cc707b257d2fe",
"target": [
{
"reference": "ExplanationOfBenefit/dc082513aed8d4d978ebedf97c02959ba104a1673e65b1bb8506266b9ad75d22"
}
],
"recorded": "2024-11-18T00:00:00+00:00",
"agent": [
{
"who": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1689634941"
},
"display": "PAUL E BOOR"
}
}
],
"meta": {
"versionId": "1a16a769-6537-4df0-9534-689cbd711fde",
"lastUpdated": "2025-04-30T14:45:58.850+00:00"
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/Provenance/84714eb2396bd1395919c108cd8a63a402f7ca49dded9473628b99311bddc32b",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "Provenance",
"id": "84714eb2396bd1395919c108cd8a63a402f7ca49dded9473628b99311bddc32b",
"target": [
{
"reference": "ExplanationOfBenefit/1528a3e9fac22a43d39b363b2112e79e48755756e8e631d7ba48d80de028d059"
}
],
"recorded": "2024-12-31T00:00:00+00:00",
"agent": [
{
"who": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1111199992"
}
}
}
],
"meta": {
"versionId": "180a0ecc-09a1-4f74-860c-befb1251d0e2",
"lastUpdated": "2025-04-30T14:45:59.043+00:00"
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/Provenance/9d4677554c199530bcc6c5557380a5d8c09508ff407b1cbeb6bfdfb83bcfd691",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "Provenance",
"id": "9d4677554c199530bcc6c5557380a5d8c09508ff407b1cbeb6bfdfb83bcfd691",
"target": [
{
"reference": "ExplanationOfBenefit/c018ffa9712426da5a30f7269b1e747f3c94c655bd2bff336b035d14fcac91b4"
}
],
"recorded": "2024-10-24T00:00:00+00:00",
"agent": [
{
"who": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1111199992"
}
}
}
],
"meta": {
"versionId": "56640537-ffe7-4266-8768-4fddc1ec024f",
"lastUpdated": "2025-04-30T14:45:59.028+00:00"
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/Provenance/39bb403c312e7584d6afe121dbff366f6edd98e3a13a2d97bffceeca0dd5dfb2",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "Provenance",
"id": "39bb403c312e7584d6afe121dbff366f6edd98e3a13a2d97bffceeca0dd5dfb2",
"target": [
{
"reference": "ExplanationOfBenefit/f3dc061604c1593516690ac955b25abf868157445be9607842d9c62ecf854754"
}
],
"recorded": "2024-10-24T00:00:00+00:00",
"agent": [
{
"who": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1111199992"
}
}
}
],
"meta": {
"versionId": "9eb83e24-e62f-4eae-817d-306e6dfaa343",
"lastUpdated": "2025-04-30T14:45:59.327+00:00"
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/Provenance/d014abf395020da59935266381dee5b28fb453ec44da009b73a6f584baf90328",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "Provenance",
"id": "d014abf395020da59935266381dee5b28fb453ec44da009b73a6f584baf90328",
"target": [
{
"reference": "ExplanationOfBenefit/cac0337ef1556abd348d940f78a98a2da577404c1c66d0b6446e0fc3a3127a86"
}
],
"recorded": "2024-10-24T00:00:00+00:00",
"agent": [
{
"who": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1111199992"
}
}
}
],
"meta": {
"versionId": "247b856d-c20f-41f6-8a4a-b4aceb717644",
"lastUpdated": "2025-04-30T14:45:59.325+00:00"
}
}
},
{
"fullUrl": "https://sandbox-fhir.humana.com/api/Provenance/fcb251a2f57a24192afbc2f17ce64c8da00a0c586012cd4bdc0fc9f7da1ee569",
"search": {
"mode": "match"
},
"resource": {
"resourceType": "Provenance",
"id": "fcb251a2f57a24192afbc2f17ce64c8da00a0c586012cd4bdc0fc9f7da1ee569",
"target": [
{
"reference": "ExplanationOfBenefit/dd13666a555b26a75a34c583eb35dd81673fab920ea5b311a5d88be9c037c105"
}
],
"recorded": "2024-09-03T00:00:00+00:00",
"agent": [
{
"who": {
"identifier": {
"system": "http://hl7.org/fhir/sid/us-npi",
"value": "1111199992"
}
}
}
],
"meta": {
"versionId": "2faf26f1-149f-4cdc-bb85-0a6c13a4b3b4",
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