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    • Type: Change Request
    • Status: Resolved - change required (View Workflow)
    • Priority: Medium
    • Resolution: Persuasive
    • Specification:
      US CARIN Real-time Pharmacy Benefit Check (RTPBC) (FHIR)
    • Raised in Version:
      0.1.0
    • Work Group:
      Pharmacy
    • Related Page(s):
      Profiles and Extensions
      Submission method
    • Resolution Description:
      Hide

      a. Make the following elements Must Support:

      • ClaimResponse.insurer, ClaimResponse.insurer.identifier
      • ClaimResponse.addItem
      • ClaimResponse.type, ClaimResponse.type.coding, ClaimResponse.type.coding.system, ClaimResponse.type.coding.code, ClaimResponse.type.coding.display
      • Claim.type, Claim.type.coding, Claim.type.coding.system, Claim.type.coding.code, Claim.type.coding.display
      • Claim.priority. Claim.priority.coding, Claim.priority.coding.system., Claim.priority.coding.code, Claim.priority.coding.display

      b. Change MedicationRequest.reasonCode.coding cardinality back to base resource's 0..1. (It was inadvertently set to 1..1)

       

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      a. Make the following elements Must Support: ClaimResponse.insurer, ClaimResponse.insurer.identifier ClaimResponse.addItem ClaimResponse.type, ClaimResponse.type.coding, ClaimResponse.type.coding.system, ClaimResponse.type.coding.code, ClaimResponse.type.coding.display Claim.type, Claim.type.coding, Claim.type.coding.system, Claim.type.coding.code, Claim.type.coding.display Claim.priority. Claim.priority.coding, Claim.priority.coding.system., Claim.priority.coding.code, Claim.priority.coding.display b. Change MedicationRequest.reasonCode.coding cardinality back to base resource's 0..1. (It was inadvertently set to 1..1)  
    • Resolution Vote:
      Scott Robertson / Pooja Babbrah : 8-0-0
    • Change Category:
      Clarification
    • Change Impact:
      Compatible, substantive
    • Applied for Version:
      0.1.0

      Description

      Neg:
      Request and Response and MedRequest profiles

      re the text:

      "Must Support elements in this profile
      Client systems

      All elements with a minimum cardinality of 1 that are also marked Must Support are essential for the responder to identify the applicable plan rules and accurately determine patient costs and coverage. The submitter MUST ensure that content in these elements is accurate and complete in order to receive reliable information in the response.
      Responding systems

      MUST make use of all pertinent information provided in the Claim request when determining cost and coverage"

      What about element not marked with Must Support?

      • are they non essential? and if so why make them min = 1
      • if they are not needed should be omitted from the profile
      • if you want them if available then they should be min = 0 and Must Support.

      Additionally if you have a MustSupport on a subelement and not on the element what does that mean? ( see ClaimResonse.addItem)

      Medrequest.reasonCode is min=0 why is that in the differential? suggest removing it

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              Assignee:
              Unassigned Unassigned
              Reporter:
              ehaas Eric Haas
              Watchers:
              1 Start watching this issue

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                Created:
                Updated:
                Resolved:
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