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  1. FHIR Specification Feedback
  2. FHIR-31634

EOB diagnosis element allows coding with display attribute-creates problems for renders

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive with Modification
    • Icon: Medium Medium
    • US CARIN Blue Button (FHIR)
    • current
    • Financial Mgmt
    • C4BB ExplanationOfBenefit Inpatient Institutional
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      It is not clear that sharing of these descriptions is permitted by license, and there is not consensus to require display values. Instead, guidance will be added as defined in  FHIR-31069.

      Summarized for this ticket:

      Add guidance in general guidance section (under CapabilityStatement Server Requirement) called "Payer Considerations for App Rendering"

      Many of the codes used in this guide are proprietary with [licensing requirements](Terminology.html). While it is recommended that consumer apps acquire the necessary licenses to show descriptions for these codes, not all app developers may be in a position to do so. Because of this, payers MAY choose to provide a concept text `[CodeableConcept].text` or the coding display `[CodeableConcept].coding.display. It is the responsibility of the payer to make sure that the descriptions provided are correct.

       

      If the 'display' element is populated, the string used in `displaySHALL be one of the display strings defined for that code by the code system (code systems may define multiple display strings for a single code).

      With the additional statement noting that "If the code description available is not known to be an exact match of a display string defined by the code system, the  `[CodeableConcept].text` should be used in place of the `[CodeableConcept].coding.display`."

       

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      It is not clear that sharing of these descriptions is permitted by license, and there is not consensus to require display values. Instead, guidance will be added as defined in   FHIR-31069 . Summarized for this ticket: Add guidance in general guidance section (under CapabilityStatement Server Requirement) called "Payer Considerations for App Rendering" Many of the codes used in this guide are proprietary with  [licensing requirements] (Terminology.html). While it is recommended that consumer apps acquire the necessary licenses to show descriptions for these codes, not all app developers may be in a position to do so. Because of this, payers  MAY  choose to provide a concept text ` [CodeableConcept] .text` or the coding display ` [CodeableConcept] .coding.display. It is the responsibility of the payer to make sure that the descriptions provided are correct.   If the 'display' element is populated, the string used in ` display `  SHALL  be one of the display strings defined for that code by the code system (code systems may define multiple display strings for a single code). With the additional statement noting that  "If the code description available is not known to be an exact match of a display string defined by the code system, the  ` [CodeableConcept] .text` should be used in place of the ` [CodeableConcept] .coding.display`."  
    • Corey Spears / Mary Kay McDaniel: 9-0-0
    • Clarification
    • Non-substantive
    • Yes
    • current

    Description

      In all EOB profiles, the constraints don't require the server to populate enough information to support rendering of coded content.  

      Currently the spec does not require the text element of the resource to be fully populated, and it does not require the text element of the coding of a codedConcept to be included and it does not require the display attribute of a codeableConcept to be populated. This does not supply enough information to support rendering of the resource by the TPA.

      Recommendation is for the profiles to require EOB.text to be populated fully by the server.  Also, the text or the display element of the codeableConcept should be required as well.

      See attached slide #3.

       

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            LisaRNelson Lisa R. Nelson
            Lisa R. Nelson
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