Details
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Change Request
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Resolution: Persuasive with Modification
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Medium
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US CARIN Blue Button (FHIR)
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current
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Financial Mgmt
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C4BB Explanation Of Benefit
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Corey Spears / Mary Kay McDaniel: 9-0-0
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Clarification
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Non-substantive
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Yes
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current
Description
Production of complete and consistent information rendering is an important information quality issue that deserves more guidance and clarity in the IG.
Organization serving up information via API need to be rendered by any variety of third party apps need to consider their responsibility to the Patients who have the right to this information.
Is there a responsibility for the Server to ensure consistent rendering of the information by supplying the EOB.text element and taking responsibility for it accuracy?
Without taking that responsibility, how could a Patient be ensured of getting access to the one definitive true rendering of the information that the Server asserts to being accurate?
Imagine this conversation between a patient and his or her health plan customer service department. "When I look at my EOB information with App A I get one story, and when I look at my EOB information with App B, I get a total different story. One way makes sense and the other way is all jumbled up and I can't make heads or tails of what its telling me."
Who has the responsibility to the Patient to put out EOB information that is clear and readable at a certain grade-level, and organized in an understandable way? I would argue–and there may be rules regarding this issue–that the supplier of this information has a responsibility to it members for ensuring the EOB information is understandable for the member. So, how could a health plan fulfill that responsibility if they offer no mechanism for rendering Apps to meet this need. The EOB information source MUST supply renderable text of the EOB information that ANY and EVERY TPA can dutifully present (at least as an option) so that members can see their EOB information in the way their health plan intended it to be presented to them. If a TPA chooses to offer additional options for viewing and interacting with the information, that should be ok too, but as a minimum the Server should supply the information, via the EOB.text element, that a TPA can dutifully render to enable the user to see their information according to the intent of the EOB information supplier who holds the responsibility to present the information to the member/user.
Without this requirement, the EOB information that actually reaches the rightful recipient can be inaccurately and inconsistently rendered, with little resemblance to the actual EOB information that member users expect and typically receive today from health plans who have the responsibility to provider members with this information.
See slide 6 for one simple example of this problem.