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  1. FHIR Specification Feedback
  2. FHIR-34087

Add guidance for use of place of service and type of bill

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    Details

    • Type: Change Request
    • Status: Applied (View Workflow)
    • Priority: Medium
    • Resolution: Persuasive
    • Specification:
      US CARIN Blue Button (FHIR)
    • Raised in Version:
      1.1.0
    • Work Group:
      Financial Mgmt
    • Related Artifact(s):
      C4BB ExplanationOfBenefit Professional NonClinician
    • Grouping:
    • Resolution Description:
      Hide

      Add the following guidance to the appropriate profile note sections.

      For the EOB Professional/Non-clinician and Oral profiles:

      • ExplanationOfBenefit.supportingInfo[servicefacility]:  Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Performing Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter. Service Facility Location identifier is the facility’s Type 2 Organization NPI if they are a health care provider as defined under HIPAA.  If the service facility is not assigned an NPI, this data element will not be populated.  Reference CMS 1500 element 32a.
      • ExplanationOfBenefit.item.location[x]: Must be the CMS Place of Service code.  If the location of the facility is different from the Billing/Performing Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter, this would be mapped to ExplanationOfBenefit.supportingInfo[servicefacility].

      For the EOB Institutional – Inpatient and Outpatient profiles

      • ExplanationOfBenefit.item.location[x] is not applicable for the Institutional Inpatient and Outpatient profiles.  For Institutional claims, the service location is defined by the first two positions of UB-04 Type of Bill.  It is mapped to ExplanationOfBenefit.supportingInfo[typeofbill] and is applicable for all line items. 
      Show
      Add the following guidance to the appropriate profile note sections. For the EOB Professional/Non-clinician and Oral profiles: ExplanationOfBenefit.supportingInfo [servicefacility] :  Service Facility Location information conveys the name, full address and identifier of the facility where services were rendered when that is different from the Billing/Performing Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter. Service Facility Location identifier is the facility’s Type 2 Organization NPI if they are a health care provider as defined under HIPAA.  If the service facility is not assigned an NPI, this data element will not be populated.  Reference CMS 1500 element 32a. ExplanationOfBenefit.item.location [x] : Must be the CMS Place of Service code.  If the location of the facility is different from the Billing/Performing Provider. Service Facility Location is not just an address nor is it a patient’s home. Examples of Service Facility Location include hospitals, nursing homes, laboratories or homeless shelter, this would be mapped to ExplanationOfBenefit.supportingInfo [servicefacility] . For the EOB Institutional – Inpatient and Outpatient profiles ExplanationOfBenefit.item.location [x] is not applicable for the Institutional Inpatient and Outpatient profiles.  For Institutional claims, the service location is defined by the first two positions of UB-04 Type of Bill.  It is mapped to ExplanationOfBenefit.supportingInfo [typeofbill] and is applicable for all line items. 
    • Resolution Vote:
      Corey Spears / Mark Roberts : 17-0-0
    • Change Category:
      Clarification
    • Change Impact:
      Non-substantive

      Description

      There is some confusion as to the difference between the place of service in the Professional NonClinician EoB and the type of bill in the institutional EoBs

      Add guidance on the use of place of service (at the item level).

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            Assignee:
            Unassigned Unassigned
            Reporter:
            corey_spears Corey Spears
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              Dates

              Created:
              Updated:
              Resolved:
              Vote Date: