Stream: implementers
Topic: CPDCS data set to FHIR profile question
Seikh Bahar (Oct 27 2020 at 17:14):
Hi all. I apologize if this is not the correct platform to ask this question.
Under patient access API rule, we are required to expose all the data covered by the data spec published (see attached word doc). Per this document, all the FHIR profiles listed in the document are needed to be exposed and they are listed here: EOB, EOB Inpatient Institutional, EOB Outpatient Institutional, EOB Professional and non-clinician, EOB Pharmacy, Patient, Practitioner, Organization and Coverage. Is there any reason/need to expose FHIR APIs that are not mentioned the CPCPDS data spec (i.e. claims, claims response) but certainly related to FHIR profiles mentioned in the CPCDS data set.
We obtained CPCDS data doc/mapping guide from the URLs below
1) http://build.fhir.org/ig/HL7/carin-bb/Common_Payer_Consumer_Data_Set.html
2) http://build.fhir.org/ig/HL7/carin-bb/Background.html#the-carin-alliance
CPCDS-Data-Dictionary-and-Resource-Mapping-Tables-0903-2020.docx
Appreciate any feedback. thanks! -seikh
David Pyke (Oct 27 2020 at 17:25):
the CMS Rule needs more than the CARIN dataset. DaVinci PDEX is also part of it which covers claims data.
Michele Mottini (Oct 27 2020 at 17:37):
..and the clinical data if there is any
Seikh Bahar (Oct 27 2020 at 19:46):
thanks @David Pyke @Michele Mottini . we are wokring on the clinical data set (USCDI). question is more on the "claim and encounter" dataset. trying to determine should we build the FHIR profiles that are mentioned in the CPCDS/CAREIN guidance or we need to build more like claims and claim response etc.. do you know the answer to that? thanks again!
David Pyke (Oct 27 2020 at 19:47):
You will need the Davinci PDEX: https://confluence.hl7.org/pages/viewpage.action?pageId=40738760
Michele Mottini (Oct 27 2020 at 20:10):
For claim data only ExplanationOfBenefit (according to the CARIN BB implementation guide), no Claim or ClaimResponse resources are needed
Seikh Bahar (Oct 29 2020 at 14:11):
Thank you both!
Christopher Fougere (Nov 03 2020 at 20:53):
@David Pyke - For the clinical data available to health plans (not necessarily claims data) wouldn't they be better served using the US Core IG vs the PDEX? this is a question we have
David Pyke (Nov 03 2020 at 21:35):
PDEX is dependent on USCore. So, when you implement PDEX, you're using USCore at the same time
Last updated: Apr 12 2022 at 19:14 UTC
