Stream: implementers
Topic: Attribution Groups
Brendan Keeler (Nov 17 2021 at 00:54):
Checking out the DaVinci ATR specification. Supposing this scenario:
Brendan Keeler (Nov 17 2021 at 00:55):
Provider 123 enters into a contract with Payer 456. Payer 456 has an internal Group on their FHIR server that represents "Provider 123 Attributed, Payer 456 Coverage Patients, as defined by Payer 456"
Brendan Keeler (Nov 17 2021 at 00:56):
Provider 123 has an internal Group on their FHIR server that represents "Provider 123 Attributed, Payer 456 Coverage Patients, as defined by Provider 123"
Brendan Keeler (Nov 17 2021 at 00:56):
When Provider 123 pulls that Group from Payer 456, two Groups then exist in Provider 123's FHIR Server for the same contract
Brendan Keeler (Nov 17 2021 at 00:57):
Which sorta contradicts this statement: Producers SHALL create one Member Attribution List represented by an instance of Group Resource. There will be exactly one Group Resource instance per Contract between a Payer and a Provider.
Brendan Keeler (Nov 17 2021 at 00:58):
I'm confused how how to appropriately represent this in FHIR
Vassil Peytchev (Nov 17 2021 at 02:06):
What does it mean "provider pulls that Group from the payer"? A FHIR GET?
Brendan Keeler (Nov 17 2021 at 04:25):
Yeah a FHIR GET. Or a POST from the payer to the provider
Brendan Keeler (Nov 17 2021 at 04:28):
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Brendan Keeler (Nov 17 2021 at 04:28):
1 or 2 here
Vassil Peytchev (Nov 17 2021 at 15:59):
In neither case does that mean that there will be two groups on the provider's FHIR server. In the case of GET, that would be fairly obvious, and in the case of POST, the server needs to add business logic to satisfy the "exactly one Group Resource instance per Contract".
The differences in the contract representation are due to the different point of view of the payer and the provider business environment. The interop FHIR specification does not have to resolve such differences, and in this case is seems that it has pointed them out appropriately.
Last updated: Apr 12 2022 at 19:14 UTC
