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Type:
Change Request
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Resolution: Persuasive with Modification
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Priority:
Medium
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FHIR Core (FHIR)
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STU3
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Financial Mgmt
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Coverage
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Andy Stechishin/Benoit Schoeffler: 6-0-0
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Compatible, substantive
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STU3
Several jusrisdicitions (even if with different approaches) have the need of managing co-payment exceptions.
Typically they apply only for health services provided and covered by the Regional / National Healthcare systems. These exceptions are linked to specific financial, age or health patient conditions.
For example Patient X has a pathology for which specific co-payment exceptions are forseeen. In that case he/she is not asked to contribute for an amount of Y each time a given diagostic exam is done, as instead requested for all the other patients.
Co-payment expectations can change over time, and often they need to be renewed.
This topic was discussed in the FM call of end of May (May 31st ?) and it was agreed to add a co-payment exception groups including a codeabelConcept indicating the type of co-payment exception; a validity period and a reference to the source of this exception. (this is what recall but i could be wrong about the last point...)
This decision is not reflected in the current Coverage resource.
- is voted on by
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BALLOT-6554 Affirmative - Giorgio Cangioli : 2018-Sep-FHIR R4
- Closed