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  1. FHIR Specification Feedback
  2. FHIR-37706

Improve guidance on Oral benefitPaymentStatus

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    • 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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      Per FHIR-37726:

      For all non-base ExplanationOfBenefit profiles (inpatient institutional, outpatient institutional, professional, oral, and pharmacy) change the ExplanationOfBenefit.supportingInfo[benefitpaymentstatus] for the header level benefit payment status will be moved to ExplanationOfBenefit.adjudication[benefitpaymentstatus]

      Change the profiles' note to reflect the change of location.

       

      Remove the following from the notes from the Oral EoB profile:

      • .item.adjudication[benefitpaymentstatus]:  place in network or out of network payment status here

       

      The change of location should make the elements more self explnatory.

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      Per FHIR-37726 : For all non-base ExplanationOfBenefit profiles (inpatient institutional, outpatient institutional, professional, oral, and pharmacy) change the ExplanationOfBenefit.supportingInfo [benefitpaymentstatus] for the header level benefit payment status will be moved to ExplanationOfBenefit.adjudication [benefitpaymentstatus] Change the profiles' note to reflect the change of location.   Remove the following from the notes from the Oral EoB profile: .item.adjudication [benefitpaymentstatus] :  place in network or out of network payment status here   The change of location should make the elements more self explnatory.
    • Corey Spears / Kathleen Conner : 13-0-0
    • Correction
    • Non-compatible

    Description

      I believe the supportinInfo benefit payment status is the header level status and the one in item.adjudication is for the line level for a line level service or product. However, there are several supportingInfo[benefitpaymentstatus] allowed. Should that be?

      Verify and add the following guidance

      Add guidance that the supportingInfo[benefitpayementstatus] is the header level status and item.adjudication is line level

      Also notes on Fields has 2 places item.adjudication[benefitpaymentstatus], but there should only be one.

      • item.adjudication[benefitpaymentstatus]:  in network or out of network payment status for the line
      • .item.adjudication[benefitpaymentstatus]:  place in network or out of network payment status here

       

       

       

       

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            corey_spears Corey Spears
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              Created:
              Updated:
              Resolved: