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  1. FHIR Specification Feedback
  2. FHIR-37562

Add guidance/requirements on use of Oral EoB body site, subsite, and additional body site

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Details

    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US CARIN Blue Button (FHIR)
    • 1.2.0
    • Financial Mgmt
    • C4BB ExplanationOfBenefit Oral
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      • Add invariant stating that at least one item.bodySite needs to be present if an item.informationSequence references supportingInfo[additionalbodysite].sequence
      • Add MS to supportingInfo[additionalbodysite].sequence
      • Add invariant requiring that each supportingInfo[additionalbodysite].sequence be referenced by at least one item.informationSequence
      • To the C4BBExplanationOfBenefitOral Notes on Fields add guidance stating: The line item primary body site (tooth or oral cavity) SHALL be specified in the .item.bodySite. Additional body sites (tooth or oral cavity) SHALL be specified in supportingInfo[additionalbodysite] repetitions with supportingInfo[additionalbodysite].sequence matching the line items .item.informationSequence
      • To the C4BBExplanationOfBenefitOral Notes on Fields add guidance stating: All Oral line item subsites (.item.subSite repetitions) apply to all the line item's associated tooth surfaces (item.bodySite and .supportingInfo[additionalbodysite] associated with the line item by referencing supportingInfo[additionalbodysite].sequence through .item.informationSequence)

       

       

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      Add invariant stating that at least one item.bodySite needs to be present if an item.informationSequence references supportingInfo [additionalbodysite] .sequence Add MS to supportingInfo [additionalbodysite] .sequence Add invariant requiring that each supportingInfo [additionalbodysite] .sequence be referenced by at least one item.informationSequence To the C4BBExplanationOfBenefitOral Notes on Fields add guidance stating: The line item primary body site (tooth or oral cavity) SHALL be specified in the .item.bodySite. Additional body sites (tooth or oral cavity) SHALL  be specified in supportingInfo [additionalbodysite] repetitions with supportingInfo [additionalbodysite] .sequence matching the line items .item.informationSequence To the C4BBExplanationOfBenefitOral Notes on Fields add guidance stating: All Oral line item subsites (.item.subSite repetitions) apply to all the line item's associated tooth surfaces (item.bodySite and .supportingInfo [additionalbodysite] associated with the line item by referencing supportingInfo [additionalbodysite] .sequence through .item.informationSequence)    
    • Corey Spears / Rachel Foerster : 7-0-2
    • Correction
    • Non-compatible

    Description

      The Oral EoB Profile ExplanationOfBenefit.item.bodySite, subsite, and ExplanationOfBenefit.supportingInfo[additionalbodysite] are related.

      Add guidance detailing the relationship, including that the bodysite should be used to the first occurrence of the body site data and that subsequent body sites, like additional tooth numbers, would appear in the supportingInfo[additionalbodysite].

      Add guidance as to whether the supportingInfo[additionalbodysite] applies to all line items or need to be linked to particular line items.

      You cannot have an additional body site without the body site. Add an Invariant that enforces that requirement.

      There is no way to link ExplanationOfBenefit.item.subsite to particular body sites (be they in item.bodySite or a supportingInfo slice). Add guidance stating that the subsite applies to all body sites on the claim.

       

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            corey_spears Corey Spears
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            Dates

              Created:
              Updated:
              Resolved: