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  1. FHIR Specification Feedback
  2. FHIR-38738

Define assumptions about what payers must verify in the GFE

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • 0.1.0 [deprecated]
    • Financial Mgmt
    • PCT Coverage
      PCT Good Faith Estimate Institutional
      PCT Good Faith Estimate Professional
      Submit a GFE resource for the creation of an AEOB
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      Added note about current member eligibility to the workflow diagram. Will add an STU note to the IG that other criteria will be evaluated during phase 2 after we receive feedback on error handling during testing and implementation. 

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      Added note about current member eligibility to the workflow diagram. Will add an STU note to the IG that other criteria will be evaluated during phase 2 after we receive feedback on error handling during testing and implementation. 
    • Rick Geimer/Jeff Brown: 9-0-0
    • Enhancement
    • Non-substantive

    Description

      Need to define assumptions about what payers must verify in the GFE such as member/subscriber eligibility. If failed, would they immediately kick it back to the submitter, or accept it then go through the whole process and finally deny it?

      This need was raised while discussing https://jira.hl7.org/browse/FHIR-34990

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            rgeimer Rick Geimer
            rgeimer Rick Geimer
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              Created:
              Updated:
              Resolved: