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  1. FHIR Specification Feedback
  2. FHIR-26708

Update HL7 Claim Type Definitions; Delete CARIN BB Claim Type Value Set and Code System

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    Details

    • Type: Change Request
    • Status: Triaged (View Workflow)
    • Priority: Highest
    • Resolution: Persuasive with Modification
    • Specification:
      US CARIN Blue Button (FHIR)
    • Raised in Version:
      0.1
    • Work Group:
      Financial Mgmt
    • Related Page(s):
      (NA)
    • Related Section(s):
      4.4.1.182
    • Resolution Description:
      Hide

      Value Set will be bound and fixed codes will be defined as requested.  

      Updates to Claim Type definitions were submitted as FHIR-28591

       

       

      Show
      Value Set will be bound and fixed codes will be defined as requested.   Updates to Claim Type definitions were submitted as FHIR-28591    
    • Change Category:
      Correction
    • Change Impact:
      Compatible, substantive

      Description

      Definitions of the Claim Type codes do not align with industry claims submissions standards.  

      Replace the definitions of  the following codes in Code System http://terminology.hl7.org/CodeSystem/claim-type with the following:  

      – institutional: Claims submitted by clinics, hospitals, skilled nursing facilities, and other institutional providers

      – professional: Claims submitted by physicians, suppliers, and other non-institutional providers

      – pharmacy: Claims submitted by retail pharmacies

      The updates do not change the meaning of the codes but add clarity to their content.  

      2) Bind EOB.type of CARINBBExplanationOfBenefit profile to ValueSet "http://hl7.org/fhir/ValueSet/claim-type" with binding strength required

      3) Set EOB.type of "Inpatient Facility" and "Outpatient Facility" profiles to the fixed code "institutional", "Pharmacy" profile to the fixed code "pharmacy" and "Professional and Non-Clinician" profile to the fixed codes "professional"

      4)  Delete CARIN Blue Button Claim Type Value Set

      5)  Delete CARIN Blue Button Claim Type Code System

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              Assignee:
              Unassigned
              Reporter:
              taylorpatriciab Patricia Taylor
              Request in-person:
              Patricia Taylor
              Watchers:
              2 Start watching this issue

                Dates

                Created:
                Updated:
                Resolved: