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  1. FHIR Specification Feedback
  2. FHIR-27008

Modify HL7 Payee Type code system descriptions; increase value set binding to required

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    Details

    • Type: Change Request
    • Status: Published (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):
      Terminology
    • Grouping:
    • Resolution Description:
      Hide

      Define Value Set:

       

      Defining URL: http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType
      Name: C4BBPayeeType
      Title: C4BB Payee Type
      Definition: Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient
      Copyright: This Value Set is not copyrighted. 
      Logical Definition: This value set includes codes from the following code systems:
      ·       Include all codes defined in http://terminology.hl7.org/CodeSystem/payeetype
      ·       Include all codes defined in http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayeeType
      Expansion: This value set contains 4 concepts
      Code Display Definition
      subscriber Subscriber The subscriber (policy holder) will be reimbursed.
      provider Provider Any benefit payable will be paid to the provider (Assignment of Benefit).
      other Other Any benefit payable will be paid to a third party such as a guarantor.
      beneficiary Beneficiary The beneficiary (patient) will be reimbursed.

       

      Bind with binding strength Required to the data element payee.type in all profiles

       

      Define Code System: 

       

      Defining URL: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayeeType
      Name: C4BBPayeeType
      Title: C4BB Payee Type
      Definition: Indicates that a payee type may be a beneficiary 
      Copyright: This Code System is not copyrighted.  
      Content:
      Code Display Definition
      beneficiary Beneficiary The beneficiary (patient) will be reimbursed.

       |

      Show
      Define Value Set:   Defining URL: http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType Name: C4BBPayeeType Title: C4BB Payee Type Definition: Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient Copyright: This Value Set is not copyrighted.  Logical Definition: This value set includes codes from the following code systems: ·       Include all codes defined in http://terminology.hl7.org/CodeSystem/payeetype ·       Include all codes defined in http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayeeType Expansion: This value set contains 4 concepts Code Display Definition subscriber Subscriber The subscriber (policy holder) will be reimbursed. provider Provider Any benefit payable will be paid to the provider (Assignment of Benefit). other Other Any benefit payable will be paid to a third party such as a guarantor. beneficiary Beneficiary The beneficiary (patient) will be reimbursed.   Bind with binding strength Required to the data element payee.type in all profiles   Define Code System:    Defining URL: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayeeType Name: C4BBPayeeType Title: C4BB Payee Type Definition: Indicates that a payee type may be a beneficiary  Copyright: This Code System is not copyrighted.   Content: Code Display Definition beneficiary Beneficiary The beneficiary (patient) will be reimbursed.  |
    • Resolution Vote:
      Pat Taylor/Mark Roberts: 24-0-2
    • Change Category:
      Correction
    • Change Impact:
      Compatible, substantive

      Description

      Ballot feedback was that the Terminology Section of the IG requires a major overall, renaming the Value Sets and Code Systems and updating links.  Following is a recommended resolution for the categories of a payer's payee type code:

      The current descriptions of Payee Type speak to payment of benefits.  Benefits may be paid by either the subscriber; i.e., deductible or co-pay, or to the provider.  Modify the descriptions to reflect that this value set identifies who received the adjudication amount   on the claim 

      1) Modify the value set description from 'This value set includes sample Payee Type codes' to 'This value set identifies the type of recipient of the adjudication amount.' 

      2)  Update the code system descriptions of the HL7 Code System http://hl7.org/fhir/R4/codesystem-payeetype.html as follows:

      • provider:  modify from 'Any benefit payable will be paid to the provider (Assignment of Benefit).' to 'The adjudication amount will be paid to the provider (Assignment of Benefit).'
      • other:  modify from 'Any benefit payable will be paid to a third party such as a guarrantor.' to 'The adjudication amount will be paid to a third party such as a guarantor.'  (note:  guarrantor should be guarantor)

      3)  Add a value:  beneficiary with the description, 'The adjudication amount will be paid to a beneficiary'

      4)  Bind with binding strength required to EOB.payee.type

       

       

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

                Dates

                Created:
                Updated:
                Resolved:
                Vote Date: