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  1. FHIR Specification Feedback
  2. FHIR-34921

On the AEOB profile, define slices for .total

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • 0.1.0 [deprecated]
    • Financial Mgmt
    • STU
    • (NA)
    • 7
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      CARIN BB provides a single adjudicationamounttype slice (1..*) on total bound to the following value set: http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication

      This value set contains codes for the requested slices, so will use a single slice with 1..* cardinality vs. multiple slices. 

      Will also add the following word smithed statement from the CARIN IG, removing past tense, etc.:

      • .total.amount:  Eligible amount = submitted amount - the noncovered amount - discount.  The subscriber pays the member liability = deductible + coinsurance + copay + noncovered (if applicable). The eligible amount - the member liability is the potential payer's payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient)

      Will create our own value set for now, and later move to THO (create separate ticket for that). 

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      CARIN BB provides a single adjudicationamounttype slice (1..*) on total bound to the following value set: http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBAdjudication This value set contains codes for the requested slices, so will use a single slice with 1..* cardinality vs. multiple slices.  Will also add the following word smithed statement from the CARIN IG, removing past tense, etc.: .total.amount:  Eligible amount = submitted amount - the noncovered amount - discount.  The subscriber pays the member liability = deductible + coinsurance + copay + noncovered (if applicable). The eligible amount - the member liability is the potential payer's payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient) Will create our own value set for now, and later move to THO (create separate ticket for that). 
    • Rick Geimer/Chris Cioffi: 9-0-0
    • Enhancement
    • Compatible, substantive
    • 1.0.0

    Description

      On the AEOB profile, define slices for .total to allow reporting of the various types of totals applicable to the claim; i.e., submitted charges, amount paid, deductible amount, etc.  Use slice definitions in C4BB Inpatient Institutional and C4BB Professional profiles as patterns

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            rhausam Robert Hausam
            taylorpatriciab Patricia Taylor
            Patricia Taylor
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              Updated:
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