Update Claim Type Definitions

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    • Type: Change Request
    • Resolution: Persuasive with Modification
    • Priority: Medium
    • FHIR Core (FHIR)
    • R4
    • Financial Mgmt
    • (NA)
    • Hide
      • Modify Claim.type comments:From:

      The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements.

      TO:

      The code system provides oral, pharmacy, vision, professional and institutional claim types. Those supported depends on the requirements of the jurisdiction. The valueset is extensible to accommodate other types of claims as required by the jurisdiction.

       

      • Add statement to the Claim Resource Scope and definition, 13.6.1. place it after the paragraph around Claim.use
        • The Claim.type code system provides oral, pharmacy, vision, professional and institutional claim types. Claim types supported are influenced by the requirements of the implementing jurisdiction. The valueset is extensible to accommodate other types of claims as required by the jurisdiction. 
      • Modify ** the Code System definitions http://terminology.hl7.org/CodeSystem/claim-type  to:
        • institutional: 
          • Claims submitted by clinics, hospitals, skilled nursing facilities, and other institutional providers.
        • oral
          • Claims submitted by Dentists and other oral health providers.
        • pharmacy
          • Claims submitted by retail pharmacies.
        • professional
          • Claims submitted by physicians, suppliers, and other professional providers.
            Note: Excludes oral health and vision providers when the oral health and vision claim types are used in that jurisdiction.**
        • vision - no change

       

      Show
      Modify Claim.type comments:From: The majority of jurisdictions use: oral, pharmacy, vision, professional and institutional, or variants on those terms, as the general styles of claims. The valueset is extensible to accommodate other jurisdictional requirements. TO: The code system provides oral, pharmacy, vision, professional and institutional claim types. Those supported depends on the requirements of the jurisdiction. The valueset is extensible to accommodate other types of claims as required by the jurisdiction.   Add statement to the Claim Resource Scope and definition, 13.6.1. place it after the paragraph around Claim.use The Claim.type code system provides oral, pharmacy, vision, professional and institutional claim types. Claim types supported are influenced by the requirements of the implementing jurisdiction. The valueset is extensible to accommodate other types of claims as required by the jurisdiction.  Modify ** the Code System definitions  http://terminology.hl7.org/CodeSystem/claim-type   to: institutional:   Claims submitted by clinics, hospitals, skilled nursing facilities, and other institutional providers. oral Claims submitted by Dentists and other oral health providers. pharmacy Claims submitted by retail pharmacies. professional Claims submitted by physicians, suppliers, and other professional providers. Note: Excludes oral health and vision providers when the oral health and vision claim types are used in that jurisdiction.** vision - no change  
    • Rachel Foerster / Gail Kocher: 6-0-0
    • Enhancement
    • Non-substantive
    • R5

      Definitions of the Claim Type codes do not align with industry claims submissions standards.  

      Replace the definitions of  the following codes in Code System http://terminology.hl7.org/CodeSystem/claim-type with the following:  

      – institutional: Claims submitted by clinics, hospitals, skilled nursing facilities, and other institutional providers

      – professional: Claims submitted by physicians, suppliers, and other non-institutional providers

      – pharmacy: Claims submitted by retail pharmacies

      The updates do not change the meaning of the codes but add clarity to their content.  

            Assignee:
            Unassigned
            Reporter:
            Patricia Taylor
            Patricia Taylor
            Watchers:
            1 Start watching this issue

              Created:
              Updated:
              Resolved: