Update the IG based on CARIN team review:

1.  Inpatient Profile:  Remove duplicate introductory verbiage.

2.  Outpatient Profile notes:  remove <p>,

 3.  Update MS-DRG CS and VS

4.  Format ICD-9 CS description

5. Section 2.1:  Replace “The goal of the CARIN Alliance Health Plan Workgroup is to develop an agreed upon set of data fields to exchange with consumers and a FHIR-based implementation guide for health plans to use to implement the API. The CARIN health plan workgroup was organized to develop a FHIR‐based API that could be implemented by a consumer‐facing application.” with “The goal of the CARIN Alliance Health Plan Workgroup is to develop an agreed upon set of data fields to exchange with consumers and a FHIR-based implementation guide for health plans and consumer facing applications to use to implement the API. “

 6. Section 2.3:  update   “Provisioning Clinical Data is defined by the DaVinci Payer Data Exchange (PDex) [insert link to section 2.5.3] and US Core Implementation Guides.”

 7. Section 4.3:  Separate the NOTE in the following like the other NOTE below it:   “Consumer App actors SHALL be able to process resource instances containing data elements asserting missing information.NOTE: The above definition of Must Support is derived from HL7v2 concept Required but may be empty - RE described in HL7v2 V28_CH02B_Conformance.doc.

8. Change “Terminology” to “Terminology Licensure” in the Guidance dropdown and in the 6 heading

 9.  Section 6.2: Change “All versions of the DRG (MS-DRG, AP-DRG, etc.) are owned by CMS. MS-DRGs are used for the Medicare population.” to “MS-DRGs are owned by CMS. MS-DRGs are used for the Medicare population.”

 10. Section 10.0.3:  Change “All EOB instances should be from one of the four non-abstract EOB profiles defined in this Implementation Guide: Inpatient, Outpatient, Pharmacy, and Professional/NonClinician” to “All EOB instances should be from one of the four concrete EOB profiles defined in this Implementation Guide: Inpatient, Outpatient, Pharmacy, and Professional/NonClinician”

 11.  Section 10.0.4:  Modify sentence within the description for C4BB Outpatient Institutional from “Outpatient claims are submitted for services rendered at a Institutional that are not part of an overnight stay.” To “Outpatient claims are submitted for services rendered at an institution that are not part of an overnight stay.”

12.  Section 10.0.4:  Description for C4BB Patient should be “This profile builds upon the US Core Patient profile. It is used to convey information about the patient who received the services described on the claim.”

 13. in the Value Set description for X12 Claim Adjustment Reason Codes - Remittance Advice Remark Codes, replace “External code lists maintained by X12 and external code lists maintained by others and distributed by WPC on behalf of the maintainer. Can be found here” with “External code lists maintained by X12 and external code lists maintained by others and distributed by WPC on behalf of the maintainer can be found here”

 14.  In the Code System description for X12 Claim Adjustment Reason Codes, replace “External code lists maintained by X12 and external code lists maintained by others and distributed by WPC on behalf of the maintainer. Can be found here” with “External code lists maintained by X12 and external code lists maintained by others and distributed by WPC on behalf of the maintainer can be found here”

 15.  Section 1.3:  Add Josh Lamb (UPMC) - lambj4@upmc.edu after Igor’s name but before the PIE Workgroup name,

16.  Add note to the EOB Abstract:  .related  If the current claim represents a claim that has been adjusted multiple times, the prior claim number should represent the most recent claim number, not the first claim number.

17.  Add note to the Professional and Non-Clinician:  A revenue code will not be available on a professional / non-clinician claim .  The cardinality of the HL7 base EOB Resource for .item.revenue is 1..1 if .item is provided.  Since item.productOrService is required it means that .item.revenue must be populated.  Since the profile is not able to relax the cardinality of the resource, it is recommended payers provide a data absent data absent reason for item.revenue.

18.  Add note to the Pharmacy  A revenue code will not be available on a professional / non-clinician pharmacy claim .  The cardinality of the HL7 base EOB Resource for .item.revenue is 1..1 if .item is provided.  Since item.productOrService is required it means that .item.revenue must be populated.  Since the profile is not able to relax the cardinality of the resource, it is recommended payers provide a data absent reason for item.revenue.

19.  Update the IP Institutional similar comment to include the word, 'reason'.

20.  Add a line before section 5.1 for readability.  

21.  Add service-date population logic.