Uploaded image for project: 'FHIR Specification Feedback'
  1. FHIR Specification Feedback
  2. FHIR-35260

Add slice requirements for AEOB adjudication categories

    XMLWordPrintableJSON

Details

    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Highest Highest
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • 0.1.0 [deprecated]
    • Financial Mgmt
    • STU
    • PCT AEOB Bundle
    • Hide

      Add the following slices to the ExplanationOfBenefit davinci-pct-aeob profile on adjudication and item.adjudication, cardinality 0..1 and MS. 

       

      Add invariant requiring submitted in adjudication.category in either the header or line level

      Add invariant requiring memberliability in adjudication.category in either the header or line level

       

      No need for paidbypatient - For estimates before a service this would always be $0 and the co-pay or collection at time of service would be reflected in those respective fields.

       

      Show
      Add the following slices to the ExplanationOfBenefit davinci-pct-aeob profile on adjudication and item.adjudication, cardinality 0..1 and MS.  submitted 0..1 MS with adjudication.category = http://terminology.hl7.org/CodeSystem/adjudication |submitted Add Short Description: Provider submitted amount memberliability 0..1 MS with adjudication.category = http://hl7.org/fhir/us/davinci-pct/CodeSystem/PCTAdjudicationCategoryType |memberliability Add Short Description: Member liability Add Comment: $0 is an acceptable value.  eligible 0..1 MS with adjudication.category = http://terminology.hl7.org/CodeSystem/adjudication |eligible  Add Short Description: Eligible amount Add Comment: Eligible is similar to allowed amount. Eligible amount and Benefit amount may be different or the same, but if they are different the payer can supply both for the full picture of the estimate.  benefit 0..1 MS with adjudication.category = http://terminology.hl7.org/CodeSystem/adjudication |benefit Add Short Description: Benefit Amount Add Comment: Eligible is similar to allowed amount. Eligible amount and Benefit amount may be different or the same, but if they are different the payer can supply both for the full picture of the estimate.   Add invariant requiring submitted in adjudication.category in either the header or line level Add invariant requiring memberliability in adjudication.category in either the header or line level   No need for paidbypatient - For estimates before a service this would always be $0 and the co-pay or collection at time of service would be reflected in those respective fields.  
    • Rachel Foerster/Rick Geimer: 11-0-0
    • Correction
    • Non-compatible

    Description

      Currently only one adjudication or total amount is required, but without distinction as to the category.

      Add slices providing more specifics on requirements.

      Suggest a cardinality of 1..1 for categories of:

      • submitted
      • memberliability

      Suggest MS for categories of:

      • paidbypatient
      • eligible
      • benefit

      Attachments

        Activity

          People

            rgeimer Rick Geimer
            corey_spears Corey Spears
            Corey Spears
            Watchers:
            4 Start watching this issue

            Dates

              Created:
              Updated:
              Resolved: