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Specification:

US CARIN Blue Button (FHIR)
Raised in Version:

1.2.0
Work Group:

Financial Mgmt
Related Artifact(s):

C4BB ExplanationOfBenefit Inpatient Institutional
C4BB ExplanationOfBenefit Oral
C4BB ExplanationOfBenefit Outpatient Institutional
C4BB ExplanationOfBenefit Pharmacy
C4BB ExplanationOfBenefit Professional NonClinician
Grouping:
- Block-Vote-8
Resolution Description:

Hide

Make change requested with a chance to remove the extra "reason" in the code and display.

Change pharmacy EOB profile from denialreason slice to rejectreason, with a fixed category code of rejectreason.

Add the following code to C4BBAdjudicationDiscriminator CodeSystem

Code Display Definition

rejectreason Reject Reason Defines the adjudication slice to identify the reject reason

Will also require changes to CPCDS and diagrams/images

Show
Make change requested with a chance to remove the extra "reason" in the code and display. Change pharmacy EOB profile from denialreason slice to rejectreason, with a fixed category code of rejectreason. Add the following code to C4BBAdjudicationDiscriminator CodeSystem Code Display Definition rejectreason Reject Reason Defines the adjudication slice to identify the reject reason Will also require changes to CPCDS and diagrams/images
Resolution Vote:
Corey Spears / Mary Kay McDaniel: 9-0-0
Change Category:
Correction
Change Impact:
Non-compatible
Pre Applied:
Yes
Applied for Version:

current

CARIN BB IG denial reason actually represents an adjustment reason (denial is only a subset of the adjudication reasons included in CARCs)

Change adjudication denialreason slices in all of the non-abstract profiles (C4BB-ExplanationOfBenefit-Outpatient-Institutional, C4BB-ExplanationOfBenefit-Inpatient-Institutional, C4BB-ExplanationOfBenefit-Professional-NonClinician, C4BB-ExplanationOfBenefit-Pharmacy, C4BB-ExplanationOfBenefit-Oral) to adjustmentreason
Update
C4BBAdjudicationDiscriminator CodeSystem denialreason to

Code	Display	Definition
adjustmentreasonreason	Adjustment Reason Reason	Defines the adjudication slice to identify the adjustment reason

relates to

FHIR-35272 Provide a means to specify a denial reason in AEOB