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  1. FHIR Specification Feedback
  2. FHIR-26516

The specification should be able to assert those elements which should be MustSupport

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    • Type: Change Request
    • Status: Resolved - change required (View Workflow)
    • Priority: Highest
    • Resolution: Persuasive
    • Specification:
      US CARIN Real-time Pharmacy Benefit Check (RTPBC) (FHIR)
    • Work Group:
      Pharmacy
    • Related Artifact(s):
      RTPBC Coverage Profile
    • Related Page(s):
      Profiles and Extensions
    • Grouping:
    • Scheduling:
    • Resolution Description:
      Hide

      Make the following adjustments to the Must Support and data population narrative in the rtpbc-coverage profile:

      • Add clarifying definitions for all of the applicable coverage-related elements: 
        • .Identifier (member ID)
        • subscriber (demographics)
        • subscriber ID (change "cardholder ID" to "subscriber ID")
        • beneficiary (patient/member demographics)
        • Coverage.class elements (rx group, rx member ID, BIN, PCN)
      • Indicate that different insurers or PBMs may require just a subset of these fields. Implementers may populate all elements for which information is available, or scope the population based the particular insurer's/PBM’s requirements
      • Clarify that a Coverage resource is not required when submitting to a pricing source. (See FHIR-25577 resolution)
      Show
      Make the following adjustments to the Must Support and data population narrative in the rtpbc-coverage profile: Add clarifying definitions for all of the applicable coverage-related elements:  .Identifier (member ID) subscriber (demographics) subscriber ID (change "cardholder ID" to "subscriber ID") beneficiary (patient/member demographics) Coverage.class elements (rx group, rx member ID, BIN, PCN) Indicate that different insurers or PBMs may require just a subset of these fields. Implementers may populate all elements for which information is available, or scope the population based the particular insurer's/PBM’s requirements Clarify that a Coverage resource is not required when submitting to a pricing source. (See FHIR-25577 resolution)
    • Resolution Vote:
      Scott Robertson / Pooja Babbrah : 8-0-0
    • Change Category:
      Clarification
    • Change Impact:
      Non-substantive
    • Applied for Version:
      0.1.0

      Description

      The specification should be able to assert those elements which should be MustSupport which would then allow the users to populate those elements which are appropriate to the sender without an additional need for coordination between senders and receivers.
      The MustSupport elemets should be determined and so flagged prior to publication.

      Existing Wording:

      Due to the variability of benefit eligibility identification approaches, implementing partners MUST establish which Must Support elements pertain to their situation.

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              Assignee:
              Unassigned Unassigned
              Reporter:
              pknapp Paul Knapp
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                Updated:
                Resolved:
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