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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
    • PCT Advanced EOB
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      CARIN BB was developed explicitly to address the post adjudicated claim use case. PCT EOB addresses a predetermination use case. The CARIN PSS scopes the IG to be post adjudicated claims only. Since these are two different use cases it is not possible for PCT to use the CARIN BB EOB profiles other than trying to align on data elements, cardinalities, code systems, and value sets, etc. Changing the CARIN BB use case would require a change to the PSS and a complete review and re-ballot of the IG.

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      CARIN BB was developed explicitly to address the  post adjudicated   claim  use case. PCT EOB addresses a  predetermination  use case. The CARIN PSS scopes the IG to be post adjudicated claims only. Since these are two different use cases it is not possible for PCT to use the CARIN BB EOB profiles other than trying to align on data elements, cardinalities, code systems, and value sets, etc. Changing the CARIN BB use case would require a change to the PSS and a complete review and re-ballot of the IG.
    • Corey Spears / Rachel Foerster : 14-0-0

    Description

      Delete the PCT AEOB Profile. Unless there's a busiess reason not to do so, modify the CARIN BB IG to accommodate AEOBs. Doing so would include requiring the value ‘predetermination’ for EOB.use, 2) defining extensions to allow verbiage for out-of-network providers, whether a service is subject to medical management and relevant disclaimers of estimates with invariants that they are to be used when the value of EOB.use is ‘predetermination’ 3) reviewing the cardinality of the CARIN IG to determine if different cardinalities should be defined for the Advanced EOB.

      If there is as business reason to define a new AEOB profile, define PCT AEOB Institutional Profiles and PCT AEOB Professional Profiles.

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