Uploaded image for project: 'FHIR Specification Feedback'
  1. FHIR Specification Feedback
  2. FHIR-34931

Terms and concepts updates - Advanced EOB

    XMLWordPrintableJSON

Details

    • 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
    • Use Case and Actors
    • 2.2
    • Hide

      Update Term:

      AEOB

      Advanced Explanation of Benefits

      Update Definition:

      The Consolidated Appropriations Act includes provisions whereby group health plans and health insurance issuers, based on charges, billing and diagnostic codes provided by the provider(s), provide an Advanced EOB for scheduled services or upon request to give patients transparency into their estimated healthcare costs. AEOBs need to include 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, as well as whether a service is subject to medical management and relevant disclaimers of estimates; for example a disclaimer that the information provided in the notification is only an estimate based on the items and services reasonably expected, at the time of scheduling (or requesting) and is subject to change. For a complete breakdown of what needs to be included in the AEOB see 42 U.S. Code 300gg-111(f)(1)(A) through (H).

      Show
      Update Term: AEOB Advanced Explanation of Benefits Update Definition: The Consolidated Appropriations Act includes provisions whereby group health plans and health insurance issuers, based on charges, billing and diagnostic codes provided by the provider(s), provide an Advanced EOB for scheduled services or upon request to give patients transparency into their estimated healthcare costs. AEOBs need to include 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, as well as whether a service is subject to medical management and relevant disclaimers of estimates; for example a disclaimer that the information provided in the notification is only an estimate based on the items and services reasonably expected, at the time of scheduling (or requesting) and is subject to change. For a complete breakdown of what needs to be included in the AEOB see  42 U.S. Code 300gg-111(f)(1)(A) through (H) .
    • Vanessa Candelora/Celine lefebvre. 9-0-0
    • Clarification
    • Non-substantive

    Description

      Modify the definition of the Advanced EOB Proposed Definition as follows: The Consolidated Appropriations Act includes provisions whereby health plans, based on charges, billing and diagnostic codes provided by the provider(s), provide an Advanced EOB 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, as well as whether a service is subject to medical management and relevant disclaimers of estimates; for example a disclaimer that the information provided in the notification is only an estimate based on the items and services reasonably expected, at the time of scheduling and is subject to change. To ensure compliance, Implementers should reference the CAA and associated regulations.

      Attachments

        Activity

          People

            Unassigned Unassigned
            sundine Sam Undine (Inactive)
            Patricia Taylor, Sam Undine (Inactive)
            Watchers:
            4 Start watching this issue

            Dates

              Created:
              Updated:
              Resolved: