Consider renaming Coverage.payor to Coverage.payer

XMLWordPrintableJSON

    • Type: Change Request
    • Resolution: Not Persuasive with Modification
    • Priority: Medium
    • FHIR Core (FHIR)
    • R4
    • Financial Mgmt
    • Coverage
    • Hide

      Will not change the Coverage.Payor element name.

      Will update the Coverage.Payor definition and comments to include text indicating that this is the issuer of the insurance policy or the part that is accepting some responsibility for payment of goods and/or services. 

      Within the  Financial Module Glossary update the definition for both payer/payor to: 

      Payer

      The term ”payer” as used in the transactions is defined as the intended entity that is responsible for one or more of the following:

      • Final processing of the claim in order to return the remittance advice.
      • Final processing of the inquiry (eligibility, services review or claim status) in order to return the response (eligibility, services review or claim status).
      • Final processing of the (member) enrollment or premium payment.
      • The person or organization who pays for the goods an/or services.

      Note: This definition excludes any business associate used to create or receive a transaction on behalf of a payer, e.g. a clearinghouse processing eligibility inquiries and response on behalf of a payer Information Source. US Realm examples of the value of a payer ID include, but are not limited to NAIC code, EIN, etc.

       

      Show
      Will not change the Coverage.Payor element name. Will update the Coverage.Payor definition and comments to include text indicating that this is the issuer of the insurance policy or the part that is accepting some responsibility for payment of goods and/or services.  Within the  Financial Module Glossary update the definition for both payer/payor to:  Payer The term ”payer” as used in the transactions is defined as the intended entity that is responsible for one or more of the following: Final processing of the claim in order to return the remittance advice. Final processing of the inquiry (eligibility, services review or claim status) in order to return the response (eligibility, services review or claim status). Final processing of the (member) enrollment or premium payment. The person or organization who pays for the goods an/or services. Note: This definition excludes any business associate used to create or receive a transaction on behalf of a payer, e.g. a clearinghouse processing eligibility inquiries and response on behalf of a payer Information Source. US Realm examples of the value of a payer ID include, but are not limited to NAIC code, EIN, etc.  
    • Kathleen Connor / Laurie Burckhardt : 9-0-0
    • Clarification
    • Non-substantive
    • R5

      Based on FHIR#18921FHIR#20985, and FHIR#26215, it seems like the DaVinci projects have settled on using "payer" (vs "payor"). However, I noticed that the base Coverage resource is still using "payor"...is there an appetite to change it?

       

      See chat at https://chat.fhir.org/#narrow/stream/179283-Da-Vinci/topic/Coverage.2Epayor

            Assignee:
            Unassigned
            Reporter:
            lmsurprenant
            Watchers:
            2 Start watching this issue

              Created:
              Updated:
              Resolved: