Remove the extension gfeReference from the AEOB profile and explicitly define the data elements necessary for the patient to understand the services and charges anticipated by the provider at the time of estimate request. Ideally, do this by replacing the AEOB profile with the Carin BB IG profile.

As currently designed, the AEOB object has a reference to the GFE that resulted in the request rather than the key GFE data embedded directly. This presents challenges as the patient themselves (nor their third party app) have a ready means to request the details of the GFE using this reference.

We believe the correct approach is to ensure enough detail is directly embedded in the profile that is used as the final AEOB format for the member to have the critical elements required to understand the services and charges the providers of services anticipated at the time of submission. However, this does not mean that the AEOB should have every exhaustive claim level detail needed to process an AEOB.

We believe our suggestion in a separate ticket to replace the new AEOB profile with the Carin BB profile does this. This profile includes all essential data for members to understand both the likely services and charges, while also fully understanding their potential liability. In the event it's determined that the CARIN IG will not suite this use case, we recommend that the necessary values be included directly in the AEOB profile.