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  1. FHIR Specification Feedback
  2. FHIR-42022

Clarification on Different Relationships from InsurancePlan to Network

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • National Directory of Healthcare Providers and Services (NDH) (FHIR)
    • 1.0.0-ballot
    • Patient Administration
    • STU
    • NDH Base InsurancePlan Profile
    • (many)
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      Need examples for the following:

      Network(s) at the base level are intended to apply to all coverages and plans if appropriate (e.g. if it includes dental in the network and dental is a covered service).   

      Networks in the coverage backbone are networks that apply only to that coverage (in addition to the base)

      Networks in the plan backbone are networks that apply only to the specific plan  (in addition to any networks define in the base or in the coverage backbone (e.g. in a Platinum plan, the network may include more expensive venues that are not covered in "lower priced plans"

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      Need examples for the following: Network(s) at the base level are intended to apply to all coverages and plans if appropriate (e.g. if it includes dental in the network and dental is a covered service).    Networks in the coverage backbone are networks that apply only to that coverage (in addition to the base) Networks in the plan backbone are networks that apply only to the specific plan  (in addition to any networks define in the base or in the coverage backbone (e.g. in a Platinum plan, the network may include more expensive venues that are not covered in "lower priced plans"
    • Bob Dieterle / David Pike : 6-0-0
    • Clarification
    • Non-substantive

      Can you clarify the difference between the multiple relationships between InsurancePlan and Network, and how the client should interpret them?

      For example:

      • Suppose my InsurancePlan resource lists Network A in the base network property, and its dental coverage lists Network B. In other words:
        • InsurancePlan.network[0] = Network A
        • InsurancePlan.coverage[0].type = "dental"
        • InsurancePlan.coverage[0].network[0] = Network B
      • Does this mean a patient with this plan can be seen at the providers in both Network A and B for dental visits, but only providers in Network A for other visit types?

      It looks like this specification was pulled from the R4 spec, but I did not see clarification there either.

            Unassigned Unassigned
            alanhu Alan Hu
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              Created:
              Updated:
              Resolved: