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  1. FHIR Specification Feedback
  2. FHIR-35146

Vision EOB as type or subtype

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Highest Highest
    • US CARIN Blue Button (FHIR)
    • current
    • Financial Mgmt
    • C4BB ExplanationOfBenefit Professional NonClinician
      C4BB Professional And Non Clinician Claim SubType Value Set
      C4BB Professional And Non Clinician Claim Type Value Set
    • 7.20.5.29. ExplanationOfBenefit.type, 7.20.5.30. ExplanationOfBenefit.subType,
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      Will move vision to a type, change invariant to point to type, and make appropriate Profile changes to support the choice of type.

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      Will move vision to a type, change invariant to point to type, and make appropriate Profile changes to support the choice of type.
    • Corey Spears / Jeff Brown: 9-0-0
    • Correction
    • Non-compatible

    Description

      The definition for C4BBExplanationOfBenefitProfessionalNonClinician ExplanationOfBenefit.type states "The category of claim, e.g. oral, pharmacy, vision, institutional, professional."  However, the binding is to C4BB Professional And Non Clinician Claim Type (required), which only allows "professional".  Vision EOB must use ExplanationOfBenefit.subtype to identify the EOB as vision (C4BB Professional And Non Clinician Claim SubType (required) contains only "vision").  This could cause confusion with implementers as it appears that "vision" would be stated as the .type, but actually must be sent as the .subtype.

       

      If there is a reason for identifying 'vision' as a subtype, it should be made clear in 7.20.1.0.2 Notes on Fields and in the Comments for ExplanationOfBenefit.type.

       

      If there is not a specific reason for 'vision' as a subtype, then 'vision' should be added to C4BB Professional And Non Clinician Claim Type (required) and removed from C4BB Professional And Non Clinician Claim SubType (required)

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            Unassigned Unassigned
            smrobertson Scott M. Robertson
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              Created:
              Updated:
              Resolved: