Stream: implementers
Topic: Claim - Pharmacy
Raja APN (May 01 2017 at 14:12):
Hi,
Can you please provide insights into whether Claim FHIR Resource (Release 3 STU) has data element(s) to map Dispensed Drug information for which the Claim is submitted? I have given the context of my request, as below.
In Pharmacy Domain, Prescription holds the Prescribed Drug and Fill (or a Refill) holds information about Dispensed Drug.
In most scenarios, the actual Dispensed Drug matches to the Prescribed Drug. However, for certain valid scenarios Pharmacy may choose to dispense a different drug to that of a Prescribed Drug.
When it comes to Pharmacy tracking corresponding Claim submission and response, it is done against a Dispensed Drug rather than Prescribed Drug.
FHIR Resource Claim has following elements, which helps to represent a given Prescription:
- prescription
- originalPrescription
Both elements refer to MedicationRequest for Release 3 STU and MedicationOrder for DSTU2.
However, there appears to be no element to map MedicationDispense to represent Fill or Refill(s).
ClaimResponse FHIR Resource, understandably, matches to the Claim that is submitted and has elements to map the adjudication and payment details.
Thanks.
Grahame Grieve (May 01 2017 at 21:04):
@Paul Knapp
Paul Knapp (May 01 2017 at 21:45):
Please see the Pharmacy claim examples and let me know if you see any issues. The dispensed drug would be a line item.service, for example:
<!-- type=packagemedication -->
<service>
<coding>
<system value="http://hl7.org/fhir/RxNorm"/>
<code value="562721"/>
<display value="Alprazolam 0.25mg (Xanax)"/>
</coding>
</service>
Sarah Cathey (Aug 28 2018 at 16:16):
I am mapping pharmacy claims data to the ExplanationOfBenefit resource, and am wondering if there are plans to add a reference to the MedicationDispense?
The EOB has a reference to MedicationRequest, however based on claims data I don't know for sure what was prescribed, just what was actually dispensed... Some of the data that I need to map fits cleanly in the MedicationDispense, but not so clearly into the EOB, for example: days supply and generic brand status.
Thanks
Lloyd McKenzie (Aug 28 2018 at 16:42):
@Paul Knapp ?
Melva Peters (Aug 28 2018 at 17:38):
Pharmacy Work Group also identified that the dispensed drug was missing from the Claim resource. I added a Gforge tracker this morning.
Sarah Cathey (Aug 30 2018 at 16:56):
FYI: I just added a Gforge tracker for the EOB: #17772
Paul Knapp (Aug 31 2018 at 15:30):
@Sarah Cathey @Melva Peters The drug dispensed would be identified in the billcode based on the jurisdictional codesystem for the medication (eg. NDC code) or the active ingredient for compounding. Is there a reason to need the dispense resource as well?
I am guessing your use case is reporting or data exchange not eClaims? Can you join a Financial Management call or can we hold a joint session in Baltimore so that we can determine what information you are looking to exchange and the best way to capture or extend the resources?
Melva Peters (Aug 31 2018 at 19:34):
Thanks @Paul Knapp that's what Pharmacy needed to know. Wasn't clear when I looked at the resource. It would be good if the Short description included a little bit more information than just repeating the name of the attribute :)
Amol Vyas (Sep 01 2018 at 00:59):
@Sarah Cathey @Melva Peters The drug dispensed would be identified in the billcode based on the jurisdictional codesystem for the medication (eg. NDC code) or the active ingredient for compounding. Is there a reason to need the dispense resource as well?
I am guessing your use case is reporting or data exchange not eClaims? Can you join a Financial Management call or can we hold a joint session in Baltimore so that we can determine what information you are looking to exchange and the best way to capture or extend the resources?
Thank you @Paul Knapp . Could you please confirm when the next Financial Management call is scheduled?
Paul Knapp (Sep 01 2018 at 12:27):
@Sarah Cathey @Melva Peters @Amol Vyas (Cambia) Please see also the Claim example: claim-example-pharmacy-medication. The FM call will be Tuesday Sept 3 11:AM-12:30 eastern using freeconference.call fm4.
Last updated: Apr 12 2022 at 19:14 UTC
