There seems to be considerable disagreement about the function of the Coverage Resource in this use case.

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    • Type: Question
    • Resolution: Considered - Question answered
    • Priority: Highest
    • US CARIN Blue Button (FHIR)
    • 0.1 [deprecated]
    • Financial Mgmt
    • (NA)
    • SD.1
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      By definition, the Coverage.type with "pay" will never display or occur in a payer issued EOB.

      InsurancePlan details are not supplied on the claim or reflected back on the EOB.

      The Coverage Profile is a reference resource of the EOB Profile.  The overview of the Coverage Profile will reflect that the coverage information provided is that which was effective as of the date of service or admission. 

      If an initiative is approved to provide a virtual current ID card capability, it will be addressed as a separate project and the API will be defined in a separate IG.  

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      By definition, the Coverage.type with "pay" will never display or occur in a payer issued EOB. InsurancePlan details are not supplied on the claim or reflected back on the EOB. The Coverage Profile is a reference resource of the EOB Profile.  The overview of the Coverage Profile will reflect that the coverage information provided is that which was effective as of the date of service or admission.  If an initiative is approved to provide a virtual current ID card capability, it will be addressed as a separate project and the API will be defined in a separate IG.  

      H.Resources (Coverage). Please clarify what the expectations are for Coverage.type wrt "pay" versus a code that indicates the Coverage Resource is representing an insurance policy. Consider also the use of an instance of InsurancePlan. Is additional modeling refinement needed to represent an individual's "insurance card" information?

            Assignee:
            Unassigned
            Reporter:
            Lisa R. Nelson
            Watchers:
            2 Start watching this issue

              Created:
              Updated:
              Resolved: