Details
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Change Request
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Resolution: Not Persuasive
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Medium
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FHIR Core (FHIR)
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R5
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Financial Mgmt
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Coverage
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13.1.4
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Paul Knapp / Kathleen Connor : 5-0-0
Description
For Account
http://build.fhir.org/account-definitions.html#Account.coverage.priority
You can specify a priority in Account which is described as
| Account.coverage.priority | |
| Element Id | Account.coverage.priority |
| Definition | The priority of the coverage in the context of this account. |
| Cardinality | 0..1 |
| Type | positiveInt |
| Alternate Names | coordination of benefit priority |
| Summary | true |
| Comments | It is common in some jurisdictions for there to be multiple coverages allocated to an account, and a sequence is required to order the settling of the account (often with insurance claiming). |
In the Coverage Resource is a field called Order
| Coverage.order | |
| Element Id | Coverage.order |
| Definition | The order of applicability of this coverage relative to other coverages which are currently in force. Note, there may be gaps in the numbering and this does not imply primary, secondary etc. as the specific positioning of coverages depends upon the episode of care. |
| Cardinality | 0..1 |
| Type | positiveInt |
| Requirements | Used in managing the coordination of benefits. |
| Summary | true |
They both appear to have the same function. I think clarification of each item's purpose is needed. Additionally if Account Resource has a priority on a Coverage of 2 but the Coverage Resource has an order of 1, how do you reconcile that difference