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  1. FHIR Specification Feedback
  2. FHIR-36114

PAS ClaimResponse and PAS Inquiry ClaimResponse use different CommunicationRequest profiles

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive
    • Icon: Medium Medium
    • US Da Vinci PAS (FHIR)
    • 1.2.0-ballot [deprecated]
    • Financial Mgmt
    • PAS Claim Inquiry Response
      PAS Claim Response
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      The 278 Inquiry and Response Transaction is intended to return the current status of a 278. It is not intended to be the vehicle through which a payer requests additional documentation. Any change to this approach needs to be addressed at X12 for their modification.

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      The 278 Inquiry and Response Transaction is intended to return the current status of a 278. It is not intended to be the vehicle through which a payer requests additional documentation. Any change to this approach needs to be addressed at X12 for their modification.
    • Bob Dieterle / Rachael Foerster : 8-0-0

    Description

      The PAS Claim Response is making use of the PASCommunicationRequest Profile.

      The PAS Claim Inquiry Response is just using the base FHIR R4 CommunicationRequest profile.

      This is pulling forward one of the more frustrating aspects of the 278 Inquiry where the payer is not able to actually request additional information on a 278 Inquiry response.

      It appears that the base CommunicationRequest might be able to support a solicited 275, but that really comes down to where the attachment control number is supposed to be returned on this profile. See related issue (https://jira.hl7.org/browse/FHIR-36097).

      In any event, if the data needs to be translated to the 278I, the identifier for this profile would have no where to go and be lost in translation since the 278I does not support PWK and returning LOINC codes in the HI segment. So continuing to use the Inquiry as the vehicle for checking on status where a payer needs to request additional documentation will continue to suffer the same shortfalls that are experienced today when attempting to utilize the scheme that is laid out by X12.

      These profiles and what is returned on the Inquiry needs to be identical between the ClaimResponse and the Claim Inquiry Response. Continuing to utilize the 278 scheme in the basis for this concept causes confusion, at best, and will not function, at worst.

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            Unassigned Unassigned
            abarbieri Andrew Barbieri
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