Uploaded image for project: 'FHIR Specification Feedback'
  1. FHIR Specification Feedback
  2. FHIR-26816

Slicing on carin-bb-explanationofbenefit- - insurance

    XMLWordPrintableJSON

    Details

    • Type: Change Request
    • Status: Resolved - change required (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)
    • Resolution Description:
      Hide

      The slicing will be removed.   Instead, insurance will be defined as 1..* with a constraint/invariant allowing no more than 1 insurance with focal=true.

      Show
      The slicing will be removed.   Instead, insurance will be defined as 1..* with a constraint/invariant allowing no more than 1 insurance with focal=true.
    • Resolution Vote:
      Mark Roberts/Pat Taylor: 18-0-5
    • Change Category:
      Correction
    • Change Impact:
      Compatible, substantive

      Description

      H.Resources (ExplanationOfBenefit). I.HTML Page Names (StructureDefinition-CARIN-BB-ExplanationOfBenefit). G.Artifact ID (carin-bb-explanationofbenefit). Closed slices shold be changed to be Open slices wherever possible to maximize future reusability and extensability for IG desiring to be dependent on this profile. For example, insurance should be changed to an Open slice in the EOB profile

      Explanation:
      The supporting.info slices should remain closed as they define industry standard value sets. The value sets are maintained by external entities such as NUBC.

      The intent of the two insurance slices is to capture the primary payer’s identification on a secondary claim.
      A person may be covered by two insurers due to, for example, both husband and wife working. The wife is primary on her insurance and secondary on her husband’s. When processing her claims, Coordination of benefits (COB) is applied. Two claims for the one visit to a physician result; one adjudicated under the primary payer and the second adjudicated under the secondary payer. For example, EOB #1 would provide the primary insurer’s identity; EOB #1 does not call out there is a secondary payer. EOB #2 would provide the secondary payer’s identification (Coverage to be used for adjudication (focal = true) and the primary payer’s identification (Coverage to be used for adjudication (focal = false)

        Attachments

          Issue Links

            Activity

              People

              Assignee:
              Unassigned
              Reporter:
              deroode David DeRoode
              Watchers:
              3 Start watching this issue

                Dates

                Created:
                Updated:
                Resolved:
                Vote Date: