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Type:
Change Request
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Resolution: Persuasive with Modification
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Priority:
Highest
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US CARIN Blue Button (FHIR)
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0.1 [deprecated]
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Financial Mgmt
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(NA)
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Terminology
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Pat Taylor/Mark Roberts: 24-0-2
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Correction
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Compatible, substantive
Ballot feedback was that the Terminology Section of the IG requires a major overall, renaming the Value Sets and Code Systems and updating links. Following is a recommended resolution for the categories of adjudication benefits:
1) Delete Value Set CARIN Blue Button Adjudication Benefit Payment Status Category Value Set
2) Define Value Set PayerBenefitPaymentStatus
4) Title: Payer Benefit Payment Status
5) Description: Indicates the in network or out of network payment status of the claim.
5) Value Set: http://hl7.org/fhir/us/ValueSet/payer-benefitpaymentstatus where values include the following codes from the Code System: in-network | out-of-network | other
6) Define a Code System: http://hl7.org/fhir/us/CodeSystem/payer-adjudication-category where values are: in-network | out-of-network | other | contracted | non-contracted | paid | denied
7) The Code System is also used to source the following Value Sets: Payer Provider Contracting Status, Claim Payment Status Code
8) Bind the ValueSet with binding strength required to the slice inoutnetwork, data element total.category in all EOB profiles.
9) Bind the ValueSet with binding strength required to the slice inoutnetwork, item.adjudication.category in the Professional and Non-Clinician Profile.
- relates to
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FHIR-26723 Description: Indicates the in network or out of network payment status of the claim
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- Published
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FHIR-25630 Essentially all the CARIN code systems have concepts with no definitions
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- Published
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