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  1. FHIR Specification Feedback
  2. FHIR-32978

Invalid invariant on Inpatient and Outpatient Institutional EoB

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    Details

    • Type: Change Request
    • Status: Resolved - change required (View Workflow)
    • Priority: Medium
    • Resolution: Persuasive
    • Specification:
      US CARIN Blue Button (FHIR)
    • Raised in Version:
      1.0.0
    • Work Group:
      Financial Mgmt
    • Related Artifact(s):
      C4BB ExplanationOfBenefit Inpatient Institutional
      C4BB ExplanationOfBenefit Outpatient Institutional
    • Grouping:
    • Resolution Description:
      Hide

      At the header level, the Invariant will be changed to the following:

      ExplanationOfBenefit: (adjudication.exists() implies adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())

       

      At the line level, the Invariant will be changed to the following:

      ExplanationOfBenefit.item: (adjudication.exists() implies adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())

       

       

      Show
      At the header level, the Invariant will be changed to the following: ExplanationOfBenefit: (adjudication.exists() implies adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())   At the line level, the Invariant will be changed to the following: ExplanationOfBenefit.item: (adjudication.exists() implies adjudication.where(category.memberOf(' http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())    
    • Resolution Vote:
      Mary Kay McDaniel/Gail Kocher: 9-0-0
    • Change Category:
      Correction
    • Change Impact:
      Compatible, substantive
    • Applied for Version:
      current

      Description

      For Inpatient and Outpatient EoB There is an incorrect invariant on ExplanationOfBenefit.adjudication and ExplanationOfBenefit.item.adjudication that is making it impossible to have an adjudication slice that is not an amount type.

      It is currently written as:

      ExplanationOfBenefit.item.adjudication: (exists() implies where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())

       

      However, since the context of the rule is item.adjudication,, the right hand operand is run on each occurrence of item.adjudication, which means that all item.adjudication must have a C4BBAdjudication code.

       

      This issue also applies to ExplanationOfBenefit.adjudication. The effect of this is that an inpatient or outpatient institutional EoB cannot have an ExplanationOfBenefit.adjudication or ExplanationOfBenefi.item.adjudication that has any slices that are not adjudicationamounttype (all have to have a category code anything from C4BBAdjudication ValueSet.

       

      This is certainly not the intent. This issue existed in the STU1.0.0 published version and still exists in the upcoming 1.1.0.

       

      The Invariant should be:

      ExplanationOfBenefit.item: (adjudication.exists() implies adjudication.where(category.memberOf('http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication')).exists())

       

      This means that is item.adjudication exists, there exists and adjudication where there is a category from C4BBAdjudication.

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            Assignee:
            Unassigned Unassigned
            Reporter:
            corey_spears Corey Spears
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              Created:
              Updated:
              Resolved:
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