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  1. FHIR Specification Feedback
  2. FHIR-34923

Overview Update

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive
    • Icon: Medium Medium
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • 0.1.0 [deprecated]
    • Financial Mgmt
    • STU
    • Use Case and Actors
    • 1.1
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      Per discussion 8/5, the community agreed to the following update to the initial paragraphs making it possible to close this ticket as not persuasive per the reporters:

      IG provides detailed guidance for providers and payers to exchange data using FHIR-based standards to support sharing financial information for specific services and items. This exchange includes a provider submitting a Good Faith Estimate (GFE) to a payer and the payer generating an Advanced Explanation of Benefits (AEOB) for a patient, and optionally for a provider, to enable better decision making by the patient in consultation with the provider. Note: This exchange will be triggered via a “request” or “scheduled service”. The AEOB will also include the GFE used to inform the AEOB generation.

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      Per discussion 8/5, the community agreed to the following update to the initial paragraphs making it possible to close this ticket as not persuasive per the reporters: IG provides detailed guidance for providers and payers to exchange data using FHIR-based standards to support sharing financial information for specific services and items. This exchange includes a provider submitting a Good Faith Estimate (GFE) to a payer and the payer generating an Advanced Explanation of Benefits (AEOB) for a patient, and optionally for a provider, to enable better decision making by the patient in consultation with the provider. Note: This exchange will be triggered via a “request” or “scheduled service”. The AEOB will also include the GFE used to inform the AEOB generation.
    • Corey Spears / Vanessa Candelora : 20-0-1

    Description

      Replace first two paragraphs with the following:
      This IG will address the use case whereby a convening provider, when scheduling a service for a patient, will provide to the patient’s payer a good faith estimate of the expected charges, billing and diagnostic codes for furnishing their services, including services reasonably expected to be provided by another health care provider. The payer, within at least three days, will provide an Advanced EOB (AEOB) for scheduled services to give patients transparency into which providers are expected to provide treatment, the network status of providers, good faith estimates of cost, cost-sharing and progress towards meeting deductibles and out-of-pocket maximums, and whether a service is subject to medical management and relevant disclaimers.

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            Unassigned Unassigned
            sundine Sam Undine (Inactive)
            Patricia Taylor, Sam Undine (Inactive)
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            Dates

              Created:
              Updated:
              Resolved: