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  1. FHIR Specification Feedback
  2. FHIR-37963

Redesign subjectToMedicalMgmt extension to support CodeableConcept and string

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • 0.1.0 [deprecated]
    • Financial Mgmt
    • PCT Advanced EOB
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      Change the subjectToMedicalMgmt extension in the following way:

      • Make value[x] 1..1 MS
      • Allow choice of value[x] to be valueCodeableConcept or valueString
      • Move the PCTSubjectToMedicalMgmtReasonVS binding from value[x] to valueCodeableConcept

       

      To davinci-pct-aeob make the following changes:

      • Remove subjectToMedicalMgmt extension from non-sliced ExplanationOfBenefit.item.adjudication
      • Add a slice to ExplanationOfBenefit.adjudication and ExplanationOfBenefit.item.adjudication with the name [medicalmanagement] 0..* and the following constraints:
        • adjudication[medicalmanagement].category = PCTAdjudicationCategoryType|medicalmanagement
        • adjudication[medicalmanagement] extension subjectToMedicalMgmt 1..1 MS
        • adjudication[medicalmanagement].amount 0..0
        • adjudication[medicalmanagement].value 0..0

       

      To the CodeSystem PCTAdjudicationCategoryType add the following code:

      Code Display Definition
      medicalmanagement Medical Management Medical management requirements, such as prior authorization, step therapy, and more.
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      Change the subjectToMedicalMgmt extension in the following way: Make value [x] 1..1 MS Allow choice of value [x] to be valueCodeableConcept or valueString Move the PCTSubjectToMedicalMgmtReasonVS binding from value [x] to valueCodeableConcept   To davinci-pct-aeob make the following changes: Remove subjectToMedicalMgmt extension from non-sliced ExplanationOfBenefit.item.adjudication Add a slice to ExplanationOfBenefit.adjudication and ExplanationOfBenefit.item.adjudication with the name [medicalmanagement] 0..* and the following constraints: adjudication [medicalmanagement] .category = PCTAdjudicationCategoryType|medicalmanagement adjudication [medicalmanagement] extension subjectToMedicalMgmt 1..1 MS adjudication [medicalmanagement] .amount 0..0 adjudication [medicalmanagement] .value 0..0   To the CodeSystem PCTAdjudicationCategoryType add the following code: Code Display Definition medicalmanagement Medical Management Medical management requirements, such as prior authorization, step therapy, and more.
    • Rachel Foerster/Rick Geimer: 11-0-0
    • Correction
    • Non-compatible

    Description

      subjectToMedicalMgmt needs to support a CodeableConcept or text. It needs to be MS and must be its own slice in EOB.adjudication and EOB.item.Adjudication.

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            rgeimer Rick Geimer
            corey_spears Corey Spears
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              Updated:
              Resolved: