Stream: implementers
Topic: Coverage Use case
Aritra Kundu (Oct 05 2020 at 11:22):
Hi Team,
I want to implement the below use case and would like to understand what are all the FHIR profiles can be used to achieve this:
• Patient login to the app (after authentication) and see his demographic information
o FHIR Resource – Patient
• Patient wants to see if he is covered for service ‘X’ (assumed to be provided by name)
o FHIR Resource – Encounter, Insurance Plan, Coverage, Coverage Eligibility Request
• For service ‘X’, what would be his responsibility (copay, coinsurance, etc)
o FHIR Resource – Coverage, Coverage Eligibility Response
Regards,
Aritra
Aritra Kundu (Oct 05 2020 at 12:35):
Aritra Kundu said:
Hi Team,
I want to implement the below use case and would like to understand what are all the FHIR profiles can be used to achieve this:
• Patient login to the app (after authentication) and see his demographic information
o FHIR Resource – Patient
• Patient wants to see if he is covered for service ‘X’ (assumed to be provided by name)
o FHIR Resource – Encounter, Insurance Plan, Coverage, Coverage Eligibility Request
• For service ‘X’, what would be his responsibility (copay, coinsurance, etc)
o FHIR Resource – Coverage, Coverage Eligibility ResponseRegards,
Aritra
@Lloyd McKenzie @Grahame Grieve Any help would be greatly appreciated.
Michele Mottini (Oct 05 2020 at 13:21):
I do not think there are any FHIR end points that will give you that data: provider do not have it (they have only clinical data) and payers give you only after-the-fact ExplanationOfBenefit and Coverage
Lin Zhang (Oct 05 2020 at 13:22):
Related project: Da Vinci
Paul Church (Oct 05 2020 at 14:02):
@Ryan Howells I believe this is a future CARIN use case but I don't know the roadmap.
Ryan Howells (Oct 05 2020 at 14:11):
Yes @Paul Church We have done some initial scoping work on this topic and are looking to advance the conversation hopefully later this year or early next depending on the availability of payers to engage.
Aritra Kundu (Oct 05 2020 at 16:13):
Lin Zhang said:
Related project: Da Vinci
Thank you for your response.
Can I Use the CRD Use case for this? http://hl7.org/fhir/us/davinci-crd/2019May/
If so, could you please validate the FHIR profiles which I mentioned. Do you feel anything else to be added?
Lin Zhang (Oct 06 2020 at 04:27):
It's an ongoing project for US Realm. And I'm not familiar with it. Sorry.
Lin Zhang (Oct 06 2020 at 04:31):
Currently, it mainly focuses on provider-payer exchange.
Last updated: Apr 12 2022 at 19:14 UTC
