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  1. FHIR Specification Feedback
  2. FHIR-35207

Disclaimer wording is awkward in MRI scenario

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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
    • Use Case and Actors
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      Replace last bullet with this:

      While medical management techniques (such as prior auth) will be included as a disclaimer when applicable in the AEOB returned to the member, the actual process of meeting medical management requirements is separate from the process of creating an AEOB. For details see the Terms and Concepts section of this IG.

       

       

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        Replace last bullet with this: While medical management techniques (such as prior auth) will be included as a disclaimer when applicable in the AEOB returned to the member, the actual process of meeting medical management requirements is separate from the process of creating an AEOB. For details see the Terms and Concepts section of this IG.    
    • Vanessa Candelora / Celine lefebvre : 9-0-0
    • Clarification
    • Non-substantive

    Description

      What is "this" in the following statement?

      • If a medical management technique, such as Prior Authorization is required, a disclaimer indicating this will be included in the Advanced EOB and does not impact the GFE, per the No Surprises Act (Section 111(a)(f)(1)(F)).

      The actual words from the act are better

      In the case such item or service is subject to
      a medical management technique (including concurrent
      review, prior authorization, and step-therapy or fail-first
      protocols) for coverage under the plan or coverage, a disclaimers that coverage for such item or service is subject
      to such medical management technique.

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            Unassigned Unassigned
            lmichaelsen Linda Michaelsen
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              Created:
              Updated:
              Resolved: