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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
    • PCT Advanced EOB
    • 7.3.1
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      Update the Benefit balance details of the Advanced EOB profile as follows:
      The following updates should be made to the benefit balance element of the profile:

      • benefitBalance element  with cardinality of 1..* .  Add a short description: If applicable to the estimate being generated (e.g. do not include estimates for mental health if the estimate is for physical therapy). 
      • benefitBalance.category:
        • should be must support
        • required pattern should be per the benefit period benefit balance financial vocab spreadsheet version 5 
        • Update description as follows: Benefit Category indicates if the overall patient’s coverage applies or a service-specific benefit applies to the cost estimate
        • Will have an extensible binding
      • benefitBalance.unit - should be be required - with cardinality 1..1 - binding should be required
      • benefitBalance.term - should be required - with cardinality 1..1 - binding should be required
      • benefitBalance.financial - should be required with cardinality 1..*
      • benefitBalance.financial.type - should be must support - binding should be per the benefit period benefit balance financial vocab spreadsheet version 5 and should be extensible
      • benefitBalance.financial.allowed[x] - should be 1..1 benefitBalance.financial.allowed.allowedMoney - should be 1..1
      • benefitBalance.financial.used[x] - should be 1..1
      • benefitBalance.financial.used.usedMoney - should be 1..1

      Will add an extension on benefitBalance.financial called remaining[x] 0..1 MS (unsignedInt and Money)

       

      Define benefitBalance.network with a lower cardinality of 1 with values from https://build.fhir.org/ig/HL7/carin-bb/ValueSet-C4BBPayerBenefitPaymentStatus.html ]

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      Update the Benefit balance details of the Advanced EOB profile as follows: The following updates should be made to the benefit balance element of the profile: benefitBalance element  with cardinality of 1..* .  Add a short description: If applicable to the estimate being generated (e.g. do not include estimates for mental health if the estimate is for physical therapy).  benefitBalance.category: should be must support required pattern should be per the benefit period benefit balance financial vocab spreadsheet version 5  Update description as follows: Benefit Category indicates if the overall patient’s coverage applies or a service-specific benefit applies to the cost estimate Will have an extensible binding benefitBalance.unit - should be be required - with cardinality 1..1 - binding should be required benefitBalance.term - should be required - with cardinality 1..1 - binding should be required benefitBalance.financial - should be required with cardinality 1..* benefitBalance.financial.type - should be must support - binding should be per the benefit period benefit balance financial vocab spreadsheet version 5 and should be extensible benefitBalance.financial.allowed [x] - should be 1..1 benefitBalance.financial.allowed.allowedMoney - should be 1..1 benefitBalance.financial.used [x] - should be 1..1 benefitBalance.financial.used.usedMoney - should be 1..1 Will add an extension on benefitBalance.financial called remaining [x] 0..1 MS (unsignedInt and Money)   Define benefitBalance.network with a lower cardinality of 1 with values from https://build.fhir.org/ig/HL7/carin-bb/ValueSet-C4BBPayerBenefitPaymentStatus.html ]
    • Rick Geimer/Pat Taylor: 16-0-5
    • Enhancement
    • Compatible, substantive

    Description

      Update the Benefit balance details of the Advanced EOB profile as follows:
      The following updates should be made to the benefit balance element of the profile:

      • benefitBalance element should be "must support" with cardinality of 1..* . An invariant should be added to require this element only when the transaction is a pre-determination (when .use = predetermination)
      • benefitBalance.Category:
      • should be must support
      • required pattern should be medical coverage
      • It should be clarified what the use of this field is. It is not unambiguously clear from the example reference set how this field is intended to be used.
      • benefitBalance.unit - should be must support - with cardinality 1..1 - binding should be required
      • benefitBalance.term - should must support - with cardinality 1..1 - binding should be required
      • benefitBalance.financial - should be must support with cardinality 1..*
      • benefitBalance.financial.type - should be must support - binding should be to C4BB Adjudication - binding should be required
      • benefitBalance.financial.allowed - should be must support
      • benefitBalance.financial.allowed.allowedMoney - should be must support
      • benefitBalance.financial.used - should be must support
      • benefitBalance.financial.used.usedMoney - should be must support

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            Unassigned Unassigned
            sundine Sam Undine (Inactive)
            Patricia Taylor, Sam Undine (Inactive)
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              Created:
              Updated:
              Resolved: