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  1. FHIR Specification Feedback
  2. FHIR-33373

Need ClaimResponse Resource added to QI Core Profiles

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US QI Core (FHIR)
    • 2.0 [deprecated]
    • Clinical Quality Information
    • QI-Core Profiles
    • 2
    • Hide

      Add a QI-Core ClaimResponse profile.
      This profile will support an example from Connectathons: https://github.com/cqframework/ecqm-content-r4-2021/blob/master/input/cql/NCQAClaims.cql
      Will provide additional example as available.
      FHIR R4 ClaimResponse
      Add Must Support for:

      • .status
      • .type
      • .use
      • .patient (reference QI-Core Patient)
      • .created (dateTime)
      • .insurer (reference QI-Core Organization)
      • .requestor (reference QI-Core Practitioner, QI-Core Organization, QI-Core PractitionerRole
      • .request (reference QI-Core Claim)
      • .item
      • .item.adjudication
      • .item.adjudication.category (preferred binding to Adjudication Value Codes)
      • .item.detail.detailSequence
      • .item.adjudication.amount
      Show
      Add a QI-Core ClaimResponse profile. This profile will support an example from Connectathons: https://github.com/cqframework/ecqm-content-r4-2021/blob/master/input/cql/NCQAClaims.cql Will provide additional example as available. FHIR R4 ClaimResponse Add Must Support for: .status .type .use .patient (reference QI-Core Patient) .created (dateTime) .insurer (reference QI-Core Organization) .requestor (reference QI-Core Practitioner, QI-Core Organization, QI-Core PractitionerRole .request (reference QI-Core Claim) .item .item.adjudication .item.adjudication.category (preferred binding to Adjudication Value Codes ) .item.detail.detailSequence .item.adjudication.amount
    • Anne Smith/Abdullah Rafiqi: 12-0-0
    • Enhancement
    • Compatible, substantive

    Description

      The ClaimsResponse Resource is needed in addition to the Claims Resource to understand if the claim was paid or denied.  Certain Quality Measures  require only paid claims to be included

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            feisenberg Floyd Eisenberg
            lmichaelsen Linda Michaelsen
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            Dates

              Created:
              Updated:
              Resolved: