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  1. FHIR Specification Feedback
  2. FHIR-35216

AEOB Item links to GFE

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • current
    • Financial Mgmt
    • STU
    • GFE Reference
      PCT Advanced EOB
      PCT-GFE-Institutional-1
    • Formal Specification
    • 4.2.2
    • Hide

      Make the following change per: FHIR-37720

      Add the following requirements for davinci-pct-aeob

      ExplanationOfBenefit.claim 1..1 

      ExplanationOfBenefit.claim.identifier 1..1

      ExplanationOfBenefit.claim.identifier.value 1..1 

      ExplanationOfBenefit.claim.identifier.system as Must Support

      ExplanationOfBenefit.claim.identifier - short description - GFE Identifier of the originally submitted claim

      ExplanationOfBenefit.claim.identifier - definition - Matches the provider submitted GFE claim.identifier this Advance ExplanationOfBenefit is addressing where identifier.type = http://terminology.hl7.org/CodeSystem/v2-0203|PLAC (with the identifier.value and identifier.system matching the original GFE identifier values)

       

      To the GFE profiles davinci-pct-gfe-Institutional and davinci-pct-gfe-professional make the following changes to identifier PLAC slice:

      Claim.identifier[PLAC].value 1..1

      Claim.identifier[PLAC].system as Must Support

       

      Show
      Make the following change per:  FHIR-37720 Add the following requirements for davinci-pct-aeob ExplanationOfBenefit.claim 1..1  ExplanationOfBenefit.claim.identifier 1..1 ExplanationOfBenefit.claim.identifier.value 1..1  ExplanationOfBenefit.claim.identifier.system as Must Support ExplanationOfBenefit.claim.identifier - short description - GFE Identifier of the originally submitted claim ExplanationOfBenefit.claim.identifier - definition - Matches the provider submitted GFE claim.identifier this Advance ExplanationOfBenefit is addressing where identifier.type = http://terminology.hl7.org/CodeSystem/v2-0203 |PLAC (with the identifier.value and identifier.system matching the original GFE identifier values)   To the GFE profiles davinci-pct-gfe-Institutional and davinci-pct-gfe-professional make the following changes to identifier PLAC slice: Claim.identifier [PLAC] .value 1..1 Claim.identifier [PLAC] .system as Must Support  
    • Rachel Foerster/Rick Geimer: 11-0-0
    • Enhancement
    • Non-compatible

      In the formal spec, it says "Note: The AEOB bundle SHALL contain one or more AEOBs. Each AEOB SHALL contain a reference to the original GFE bundle."

      This seems a little unhelpful without a good reference from the AEOB item to the GFE it is based on (not the bundle). If the GFE had an identifier outside of standard codes (something unique), then the AEOB item could reference that identifier.

      This would be very useful for any patient-facing proxy that is sending the GFE bundle and receiving the AEOB bundle. The mapping would make it easier to update the data that was used to create the GFE bundle. 

            Unassigned Unassigned
            terskine Tyler Erskine
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              Created:
              Updated:
              Resolved: