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  1. FHIR Specification Feedback
  2. FHIR-38097

ExplanationOfBenefit description clarification for use of item level, header level adjudication

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US Da Vinci PDex (FHIR)
    • 2.0.0-ballot [deprecated]
    • Financial Mgmt
    • PDex Prior Authorization
    • Hide

      Removed Invariant that prevents Item Adjudication at Header AND line level

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      Removed Invariant that prevents Item Adjudication at Header AND line level
    • Bob Dieterle / MaryKay McDaniel: 8-0-0
    • Correction
    • Compatible, substantive
    • Yes
    • 2.0.0-ballot [deprecated]

      From https://build.fhir.org/ig/HL7/davinci-epdx/StructureDefinition-pdex-priorauthorization.html description

      "EOB-institutional-item-or-header-adjudication: Institutional EOB: Should have adjudication at the item or header level, but not both."

      Is the constraint that adjudication cannot be at both item & header level applicable only for claims because for prior auth we have adjudication at both item (product or service) and header (authorization) level. 

            Unassigned Unassigned
            kdlakhesar Kuldeep Lakhesar
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              Created:
              Updated:
              Resolved: