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  1. FHIR Specification Feedback
  2. FHIR-44778

Create an GFE Summary Profile to add to the GFE Bundle

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Details

    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • 1.1.0
    • Financial Mgmt
    • PCT GFE Bundle
    • Corey Spears / Celine Lefebvre: 6-0-1
    • Enhancement
    • Non-compatible

    Description

      Create an GFE Summary Profile to add to the GFE Bundle

      Based on the individual GFE and the choices/approach of the AEOB Summary requested in FHIR-42827 

      With the following in Claim

      • Type 1..1 (extensible) 
        • Add “estimate-summary” code
      • Provider 1..1
        • Add Data Absent Reason extension, value: not-applicable; Don’t allow other elements under Claim.provider.
      • Use Claim.billablePeriod (MS) for full Period of care
      • Require Claim.total  (1..1)
      • Disallow elements that are specific to an individual claim or would not properly be reflected or interpreted as “summary”
        • subtype (0..0) – More granular claim type (e.g. inpatient, outpatient, ortho, emergency) (Type is summary)
        • enterer (0..0) – Author of the claim – 0..1 Reference(Practitioner | PractitionerRole)
        • insurer as MS
        • prescription (0..0) – Prescription authorizing services or products – 0..1 Reference(MedicationRequest | VisionPrescription)
        • originalPrescription (0..0) – Original prescription if superseded by fulfiller 0..1 Reference(MedicationRequest)
        • payee (0..0) – Recipient of benefits payable 0..1
        • referral (0..0) – Treatment Referral 0..1
        • supportingInfo (0..0) – Not used in individual GFE, used in regular Claims for admit type, claim rcv date, point of origin, drg, etc.
        • item (0..0) – Individual claim line items
        • addItem (0..0) – Claim specific Insurer added line items
        • fundsReserveRequested (0..0) – A code to indicate whether and for whom funds are to be reserved for future claims.
        • fundsReserve (0..0) – A code, used only on a response to a preauthorization, to indicate whether the benefits payable have been reserved and for whom.

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            corey_spears Corey Spears
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            Dates

              Created:
              Updated:
              Resolved: