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  1. FHIR Specification Feedback
  2. FHIR-34961

Detailed Requirements Summary

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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
    • Formal Specification
    • 4.2.1
    • Hide

      Addressing the various parts of the issue:

      1. Add " This guide requires `predetermination` for both Claim.use and ExplanationOfBenefits.use."  after "These uses are distinguished by the Claim.use and ExplanationOfBenefit.use code."
      2. Access by the patient will remain an option via OAuth2 and REST (similar to the Patient Access API). It is simply the patient doing a query for their AEOBs.
      3. With the move to the https://build.fhir.org/async-bundle.html pattern, the status of the request will be defined by HTTP return codes and will no longer be a part of the AEOB bundle. 
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      Addressing the various parts of the issue: Add " This guide requires `predetermination` for both Claim.use and ExplanationOfBenefits.use."  after "These uses are distinguished by the Claim.use and ExplanationOfBenefit.use code." Access by the patient will remain an option via OAuth2 and REST (similar to the Patient Access API). It is simply the patient doing a query for their AEOBs. With the move to the https://build.fhir.org/async-bundle.html pattern, the status of the request will be defined by HTTP return codes and will no longer be a part of the AEOB bundle. 
    • Rick Geimer/Paul Knapp: 9-0-1
    • Clarification
    • Compatible, substantive

    Description

      1. Add the following sentence to the first paragraph:  The value of Claim.use and ExplanationOfBenefits.use is 'predetermination'. 
      2.  Remove the requirement that the patient may poll the payer server.  Note that the capability for the provider to poll the payer server is a SHOULD requirement.
      3.  Re 'The AEOB bundle will contain one of these outcomes queued | complete | error | partial' - is this intended for the provider to query the status of the GFE bundle?  If so, it should be defined in the GFE bundle. 

      The AEOB profile outcome will always have a value of 'complete' as the EOB will be adjudicated.  The description of the outcome is confusing - it references the AEOB Bundle and the content of the AEOB Bundle – Remove the sentence.  |

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            rgeimer Rick Geimer
            sundine Sam Undine (Inactive)
            Patricia Taylor, Sam Undine (Inactive)
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              Updated:
              Resolved: