Stream: implementers
Topic: Carin EOB Processing Field
ava1uphealth (Mar 15 2021 at 15:35):
I recently discovered 3 equations in the “Notes on Fields” section of the EOB pages in Carin. The equations are:
(1) Eligible amount = submitted amount - the noncovered amount – discount
(2) member liability = deductible + coinsurance + copay + noncovered
(3) payment amount = eligible amount - the member liability
For us equations (1) and (3) are particularly problematic.
Question: Is it okay for our claims to violate these 2 equations in FHIR? Our client's claims processing system does not work the way FHIR expects and they would like to largely disregard these 2 equations. Will that be a problem?
Lloyd McKenzie (Mar 15 2021 at 20:51):
@Paul Knapp
Paul Knapp (Mar 23 2021 at 15:43):
@ava1uphealth CARIN has provided those equations as guidance, could you please advise as to what parts of the equations you differ on? @Pat Taylor @Amol Vyas @Mark Roberts
Last updated: Apr 12 2022 at 19:14 UTC
