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  1. FHIR Specification Feedback
  2. FHIR-37769

Required fields not mapped

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci PAS (FHIR)
    • 1.2.0-ballot [deprecated]
    • Financial Mgmt
    • PAS Claim
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      For claims that are being sent as FHIR and converted to X12, there will be no patient event as the FHIR Claim only has line items.  The FHIR Claim line items are converted to service line items in the X12 claim and thus there will not be any need for the 2000E HSD01 or HSD02 mapping as those will never be created.

      The response mapping is incorrect - the 2000E HSD should not be mapped and the 2000F HSD01/02 should be mapped to the specific item.quantity field in the response.

      We will add a section with a note to implementers to Supported Use Cases to discuss the fact that the FHIR Claim resource only has line items and that this might have some ramifications for systems that are expecting certain of types of authorizations to be at the patient level.

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      For claims that are being sent as FHIR and converted to X12, there will be no patient event as the FHIR Claim only has line items.  The FHIR Claim line items are converted to service line items in the X12 claim and thus there will not be any need for the 2000E HSD01 or HSD02 mapping as those will never be created. The response mapping is incorrect - the 2000E HSD should not be mapped and the 2000F HSD01/02 should be mapped to the specific item.quantity field in the response. We will add a section with a note to implementers to Supported Use Cases to discuss the fact that the FHIR Claim resource only has line items and that this might have some ramifications for systems that are expecting certain of types of authorizations to be at the patient level.
    • Bob Dieterle / Jeff Brown : 8-0-0
    • Clarification
    • Non-substantive

    Description

      Payers supported by Availity would like to receive, in the PAS request bundle, specific content corresponding to the 2000E HSD01 and HSD02 segments of a 278. According to X12’s Glass these fields are not mapped in the request, but are however mapped in the response.

      Some payers require these data elements for outpatient authorizations.

      This change request is to provide the ability to communicate this information in the PAS request. Availity's short term solution is it to map the information to ServiceRequest.quantityQuantity.unit and ServiceRequest.quantityQuantity.value. Our rationale is that these fields are what are used to communicate this information on the response, so it seemed logical to use them in the request.

       

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            Unassigned Unassigned
            skb_availity Susan Bellile
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              Created:
              Updated:
              Resolved: