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  1. FHIR Specification Feedback
  2. FHIR-34947

should state the close relationship between GFEs/AEOBs and X12 claims/ERAs

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Highest Highest
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • current
    • Financial Mgmt
    • Use Case and Actors
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      8/5/2022 the community discussed revisions to the Overview section and edits addressing this ticket were approved by the submitter and the community. To address this ticket, the relevant language in the Overview section will now read:

      This IG describes system interactions using the FHIR standard. This IG will reference where possible the “standards” defined by the Health Record exchange (HRex) Library/Framework IG, other FHIR IGs, and other industry standards where applicable.

      HL7 and X12 have worked collaboratively to support implementers to align requirements with claim submission standards to ease the burden of implementation where possible, there is no requirement to use other administration/payment transmission standards and there is no HIPAA mandate to do so for this use case.

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      8/5/2022 the community discussed revisions to the Overview section and edits addressing this ticket were approved by the submitter and the community. To address this ticket, the relevant language in the Overview section will now read: This IG describes system interactions using the FHIR standard. This IG will reference where possible the “standards” defined by the Health Record exchange ( HRex ) Library/Framework IG, other FHIR IGs, and other industry standards where applicable. HL7 and X12 have worked collaboratively to support implementers to align requirements with claim submission standards to ease the burden of implementation where possible, there is no requirement to use other administration/payment transmission standards and there is no HIPAA mandate to do so for this use case.
    • Corey Spears / Vanessa Candelora : 20-0-1
    • Clarification
    • Non-substantive

    Description

      While this is true, we expect the GFE submission to mirror claim submission, and the AEOB creation to mirror ERA production – so both providers and payers will likely be heavily leveraging existing X12 transactions and EDI workflows to fulfill the NSA requirements. Recommend clearly stating the close relationship between GFEs/AEOBs and X12 claims/ERAs.

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            celine_lefebvre Celine Lefebvre
            Celine Lefebvre
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              Updated:
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