# hl7.fhir.us.carin-bb 2.0.0 → 2.2.0 — version-difference evidence pack

The densest per-profile delta: 573 requirement changes over just 11 profiles present in both versions, most of them binding and target-profile changes.

This pack is the downloadable form of the public report at `/ig-gap/carin-bb-2-0-0-to-2-2-0`. It is per-pair and carries public content only; the cross-pair rollup and arbitrary-pair export remain a separate, gated capability (IG-115 / Suite B).

## Inputs

| Side | Package | sha256 |
|---|---|---|
| Baseline | `hl7.fhir.us.carin-bb#2.0.0` | `3a2d672a807eb53c27fca1a9ad30c8374bbd43b895009b15ced5e69ab015effa` |
| Target | `hl7.fhir.us.carin-bb#2.2.0` | `29b7f427899be281ad242154d2e0d136900a679d839347778191f883420a196a` |

Engines: comparison 1.0.0 · normalization 1.3.0 · schema v2 · generator 1.1.0 · inputs hash `0d152adea100b3b5c8a2c2f0012f5102`

These two archives, identified by SHA-256, are the complete input. Anyone can fetch them and confirm they are looking at the same bytes this analysis read. The analysis itself is ImOnFHIR's.

There is deliberately no generation timestamp: the report is a pure function of the two archives, so the digests date it better than a clock would.

## The shape of the change

573 element-level requirement changes, each graded to exactly one tier — every count in this pack is complete, computed over the full change set.

| Tier | Count |
|---|---|
| Critical | 7 |
| Needs review | 214 |
| Indeterminate | 0 |
| Informational | 352 |
| **Total** | **573** |

### Read the element counts as a floor

5 profiles exist only in 2.2.0. Those have no counterpart to compare against, so they contribute no element-level rows — the element comparison covers the 11 profiles present in both versions. Neither number is a total on its own.

The 592 mandatory or must-support elements attributed to added profiles are counted from each profile’s effective element list; where a profile ships no snapshot that list is reconstructed by merging its differential onto its base, so treat the figure as indicative rather than audited.

## Where the change concentrates

Most breaking changes (absolute critical count):

- `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional` — 2 critical of 90 changes
- `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional` — 2 critical of 83 changes
- `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy` — 1 critical of 92 changes

Most sharply changed (critical share; profiles with at least 5 changes — the floor keeps one-change profiles from scoring 100%):

- `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional` — 2% of 83 changes critical
- `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional` — 2% of 90 changes critical
- `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician` — 1% of 85 changes critical

## The other planes

| Plane | Changes | Highest severity present |
|---|---|---|
| Operations | 0 | — |
| Value sets | 29 | needs review |
| Capability statements | 0 | — |

## Profile coverage

Compared in both versions: 11 · added in target: 5 · removed from baseline: 0

- PROFILE_ADDED `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional-Basis`
- PROFILE_ADDED `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional-Basis`
- PROFILE_ADDED `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy-Basis`
- PROFILE_ADDED `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral-Basis`
- PROFILE_ADDED `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician-Basis`

## Changes by effect

| Effect | Count |
|---|---|
| informational change | 4 |
| invariant added | 10 |
| invariant changed | 27 |
| invariant removed | 7 |
| newly required | 7 |
| new support expectation | 22 |
| no longer required | 8 |
| profile inheritance changed | 10 |
| reference requirement changed | 126 |
| slice added | 6 |
| slice cardinality changed | 5 |
| slice removed | 8 |
| support expectation removed | 12 |
| target profile expanded | 3 |
| valueset reference changed | 318 |

## Sampled evidence rows

Every count above is complete. The rows below are a bounded, deterministic sample of 40 (533 further changes are counted above but not sampled here), chosen so every kind of change and the most-affected profiles are each represented. Each row carries its stable change id — cite the id, not the prose; the id survives regeneration, the prose may not.

- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.adjudication.amount|adjudicationamounttype|MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.adjudication.amount` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.item.adjudication.amount|adjudicationamounttype|MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.item.adjudication.amount` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral|ExplanationOfBenefit.item.adjudication.amount|adjudicationamounttype|MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Oral`
  - element: `ExplanationOfBenefit.item.adjudication.amount` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional|ExplanationOfBenefit.adjudication.amount|adjudicationamounttype|MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional`
  - element: `ExplanationOfBenefit.adjudication.amount` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional|ExplanationOfBenefit.item.adjudication.amount|adjudicationamounttype|MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional`
  - element: `ExplanationOfBenefit.item.adjudication.amount` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy|ExplanationOfBenefit.item.adjudication.amount|adjudicationamounttype|MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Pharmacy`
  - element: `ExplanationOfBenefit.item.adjudication.amount` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician|ExplanationOfBenefit.item.adjudication.amount|adjudicationamounttype|MIN_CARDINALITY||:NEWLY_REQUIRED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Professional-NonClinician`
  - element: `ExplanationOfBenefit.item.adjudication.amount` · newly required · critical
  - 0 → 1
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|Coverage.identifier|memberid|SLICING|memberid|:SLICE_ADDED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage`
  - element: `Coverage.identifier` · slice added · needs review
  - — → {"sliceName":"memberid","min":0,"max":"1"}
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|Coverage.meta.profile||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage`
  - element: `Coverage.meta.profile` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/StructureDefinition"] → ["http://hl7.org/fhir/StructureDefinition/StructureDefinition|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|Coverage.type||MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage`
  - element: `Coverage.type` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|Coverage||INVARIANT|us-core-15|:INVARIANT_ADDED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage`
  - element: `Coverage` · invariant added · needs review
  - — → {"key":"us-core-15","severity":"error","human":"Member Id in Coverage.identifier or Coverage.subscriberId SHALL be present","expression":"identifier.type.coding.where(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MB').exists() or subscriberId.exists()","xpath":"f:identifier or f:subscriberId","source":"http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage"}
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|Coverage||PROFILE_INHERITANCE||:PROFILE_INHERITANCE_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage`
  - element: `Coverage` · profile inheritance changed · needs review
  - http://hl7.org/fhir/StructureDefinition/Coverage → http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage|7.0.0
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.accident.location[x]||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.accident.location[x]` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/Location"] → ["http://hl7.org/fhir/StructureDefinition/Location|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.addItem.location[x]||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.addItem.location[x]` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/Location"] → ["http://hl7.org/fhir/StructureDefinition/Location|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.addItem.provider||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.addItem.provider` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole","http://hl7.org/fhir/StructureDefinition/Organization"] → ["http://hl7.org/fhir/StructureDefinition/Practitioner|4.0.1","http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.0.1","http://hl7.org/fhir/StructureDefinition/Organization|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.adjudication.category|adjudicationamounttype|BINDING||:VALUESET_REFERENCE_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.adjudication.category` · valueset reference changed · needs review
  - {"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"Adjudication"}],"strength":"example","description":"The adjudication codes.","valueSet":"http://hl7.org/fhir/ValueSet/adjudication"} → {"strength":"required","valueSet":"http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"}
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.adjudication.category|adjudicationamounttype|MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.adjudication.category` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.careTeam||INVARIANT|EOB-inst-careTeam-practitioner|:INVARIANT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.careTeam` · invariant changed · needs review
  - {"key":"EOB-inst-careTeam-practitioner","severity":"error","human":"Institutional EOB: Careteam roles refer to a practitioner","expression":"(\nrole.where(coding.where(code in ('attending' | 'primary' | 'referring' | 'supervising')).exists()).exists() implies\nrole.where(coding.where(code in ('attending' | 'primary' | 'referring' | 'supervising')).exists()).exists().provider.all(resolve() is Practitioner)\n)","source":"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional"} → {"key":"EOB-inst-careTeam-practitioner","severity":"error","human":"Institutional EOB: Careteam roles refer to a practitioner","expression":"(role.where(coding.where(code in ('attending' | 'primary' | 'referring' | 'supervisor')).exists()).exists() implies provider.all(resolve() is Practitioner))","source":"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional-Basis"}
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.claimResponse||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.claimResponse` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/ClaimResponse"] → ["http://hl7.org/fhir/StructureDefinition/ClaimResponse|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.claim||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.claim` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/Claim"] → ["http://hl7.org/fhir/StructureDefinition/Claim|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.diagnosis.onAdmission||VALUESET_REFERENCE||:VALUESET_REFERENCE_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.diagnosis.onAdmission` · valueset reference changed · needs review
  - {"strength":"required","valueSet":"http://hl7.org/fhir/us/carin-bb/ValueSet/AHANUBCPresentOnAdmission"} → {"strength":"required","valueSet":"http://hl7.org/fhir/us/carin-bb/ValueSet/CMSPresentOnAdmissionIndicator"}
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.enterer||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.enterer` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/Practitioner","http://hl7.org/fhir/StructureDefinition/PractitionerRole"] → ["http://hl7.org/fhir/StructureDefinition/Practitioner|4.0.1","http://hl7.org/fhir/StructureDefinition/PractitionerRole|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.facility||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.facility` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/Location"] → ["http://hl7.org/fhir/StructureDefinition/Location|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.identifier.assigner|uniqueclaimid|TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.identifier.assigner` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/Organization"] → ["http://hl7.org/fhir/StructureDefinition/Organization|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.insurance||INVARIANT|EOB-insurance-focal|:INVARIANT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.insurance` · invariant changed · needs review
  - {"key":"EOB-insurance-focal","severity":"error","human":"EOB.insurance:  at most one with focal = true","expression":"insurance.select (focal = true).count() < 2","source":"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit"} → {"key":"EOB-insurance-focal","severity":"error","human":"EOB.insurance:  at most one with focal = true","expression":"select (focal = true).count() < 2","source":"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit"}
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.item.adjudication.amount|adjudicationamounttype|MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.item.adjudication.amount` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.item.adjudication.category|adjudicationamounttype|BINDING||:VALUESET_REFERENCE_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.item.adjudication.category` · valueset reference changed · needs review
  - {"extension":[{"url":"http://hl7.org/fhir/StructureDefinition/elementdefinition-bindingName","valueString":"Adjudication"}],"strength":"example","description":"The adjudication codes.","valueSet":"http://hl7.org/fhir/ValueSet/adjudication"} → {"strength":"required","valueSet":"http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication"}
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.item.detail.subDetail.udi||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.item.detail.subDetail.udi` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/Device"] → ["http://hl7.org/fhir/StructureDefinition/Device|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.item.detail.udi||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.item.detail.udi` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/Device"] → ["http://hl7.org/fhir/StructureDefinition/Device|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.item.encounter||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.item.encounter` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/Encounter"] → ["http://hl7.org/fhir/StructureDefinition/Encounter|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit|ExplanationOfBenefit.accident.location[x]||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit`
  - element: `ExplanationOfBenefit.accident.location[x]` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/Location"] → ["http://hl7.org/fhir/StructureDefinition/Location|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization|Organization.identifier|CLIA|INVARIANT|us-core-18|:INVARIANT_ADDED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Organization`
  - element: `Organization.identifier` · invariant added · needs review
  - — → {"key":"us-core-18","severity":"error","human":"CLIA number must be 10 digits with a letter \"D\" in third position","expression":"value.matches('^[0-9]{2}D[0-9]{7}$')","xpath":"f:value/f:matches(value,/^[0-9]{2}D[0-9]{7}$/)"}
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient|Patient.extension|genderIdentity|SLICING|genderIdentity|:SLICE_ADDED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Patient`
  - element: `Patient.extension` · slice added · needs review
  - — → {"sliceName":"genderIdentity","min":0,"max":"*"}
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner|Practitioner.address||MUST_SUPPORT||:NEW_SUPPORT_EXPECTATION`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Practitioner`
  - element: `Practitioner.address` · new support expectation · needs review
  - false → true
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-RelatedPerson|RelatedPerson.meta.profile||TARGET_PROFILE||:REFERENCE_REQUIREMENT_CHANGED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-RelatedPerson`
  - element: `RelatedPerson.meta.profile` · reference requirement changed · needs review
  - ["http://hl7.org/fhir/StructureDefinition/StructureDefinition"] → ["http://hl7.org/fhir/StructureDefinition/StructureDefinition|4.0.1"]
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|Coverage||INVARIANT|coverage-meta-profile-version|:INVARIANT_REMOVED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage`
  - element: `Coverage` · invariant removed · informational
  - {"key":"coverage-meta-profile-version","severity":"error","human":"Coverage: meta.profile with canonical and major.minor. version required.","expression":"meta.profile.exists($this.startsWith('http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage|2.0.'))","source":"http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-Coverage"} → —
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.adjudication.reason|adjudicationamounttype|MIN_CARDINALITY||:NO_LONGER_REQUIRED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.adjudication.reason` · no longer required · informational
  - 1 → 0
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.adjudication.reason|adjudicationamounttype|MUST_SUPPORT||:SUPPORT_EXPECTATION_REMOVED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.adjudication.reason` · support expectation removed · informational
  - true → false
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.item.adjudication.value|adjudicationamounttype|MIN_CARDINALITY||:NO_LONGER_REQUIRED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.item.adjudication.value` · no longer required · informational
  - 1 → 0
- `req:http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional|ExplanationOfBenefit.item.adjudication.value|adjudicationamounttype|MUST_SUPPORT||:SUPPORT_EXPECTATION_REMOVED`
  - profile: `http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Inpatient-Institutional`
  - element: `ExplanationOfBenefit.item.adjudication.value` · support expectation removed · informational
  - true → false

## Who maintains this guide, per our register

Where standards work on this guide happens — the room a ballot comment or a question should go to. Quoted from our workgroup register; sourced from the guide's own published footer attribution.

- HL7 International / Financial Management (owner) — https://www.hl7.org/Special/committees/fm · https://hl7.org/fhir/us/davinci-pas/en/index.html — reviewed 2026-07-26

## What this pack is not

Not a compliance assessment. The comparison carries no deadline and renders no verdict about any organization or implementation. Observed validator differences are not automatic proof of official IG requirement changes.