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  1. FHIR Specification Feedback
  2. FHIR-26721

Define the various payer adjudication amount fields in the EOB adjudication section

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    Details

    • Type: Change Request
    • Status: Deferred (View Workflow)
    • Priority: Highest
    • Resolution: Considered for Future Use
    • Specification:
      US CARIN Blue Button (FHIR)
    • Raised in Version:
      0.1
    • Work Group:
      Financial Mgmt
    • Related Page(s):
      (NA)
    • Related Section(s):
      NEW
    • Resolution Description:
      Hide

      Consider in the next FHIR version

      Show
      Consider in the next FHIR version
    • Resolution Vote:
      Mark Roberts/Pat Taylor: 18-0-5

      Description

      H.Resources (Claim / ClaimResponse / ExplanationOfBenefits). I.HTML Page Names (https://www.hl7.org/fhir/claim.html
      https://www.hl7.org/fhir/claimresponse.html

      https://www.hl7.org/fhir/explanationofbenefit.html). Description: Describes the various amount fields used when payers receive and adjudicate a claim.
      Values are submitted | eligible | deductible |coinsurance | copay | noncovered | priorpayerpaid | benefit | paidbypatient | paidtoprovider | paidtopatient | memberliability | discount | drugcost
      The data element resides in all claims.

      Existing Wording:

      The IG defines the Adjudication Amount Category as supporting.info

      Proposed Wording:

      Define these data elements within the adjudication section

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              Assignee:
              Unassigned Unassigned
              Reporter:
              taylorpatriciab Patricia Taylor
              Watchers:
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                Dates

                Created:
                Updated:
                Resolved:
                Vote Date: