Stream: implementers
Topic: Coverage question
Jay Lyle (Mar 22 2019 at 20:59):
We wish to provide a resource to answer a specific question about coverage - which 1-3 eligibility categories out of 8 does a patient fall into?
Coverage seems a bit heavy. Observation seems a little klugey. CoverageEligibilityResponse sounds right, but it, too, bakes in a lot of spurious metadata, and one of the approaches would use Coverage in there, too. (Or we could DAR out the Coverage or provide a boilerplate display text and use one of the insurance.item codes - category or type.)
Is anyone else facing a similar question?
Andy Stechishin (Mar 22 2019 at 21:38):
I think that @Paul Knapp probably is the best person to answer this Jay. I think the the CoverageEligibilityResponse is the correct resource for your question about coverage. Not sure about the 'spurious metadata' comment as the items were added to support specific requirements and reviewed by the FM work group prior to inclusion in the published resource.
Lloyd McKenzie (Mar 22 2019 at 22:40):
Is it mandatory spurious metadata? Not all use-cases need to populate all elements. However, elements shouldn't be mandatory if there are use-cases that don't need them.
Andy Stechishin (Mar 22 2019 at 23:11):
I do not believe any of the elements in question are mandatory as that would be bad information design to require items without proper consideration
Lloyd McKenzie (Mar 22 2019 at 23:18):
Then it should be possible to create an instance that just skips the data that's not relevant. (For Patient, sometimes anything more than name + identifier is spurious, but that doesn't mean it's wrong for the resource to have those elements.)
Andy Stechishin (Mar 22 2019 at 23:22):
yup, that was pretty much what I said
Paul Knapp (Mar 25 2019 at 18:51):
@Jay Lyle Hi Jay, do you mind sharing with me some more details about or an example of your use case?
Jay Lyle (Mar 26 2019 at 15:16):
Sure. The word "spurious" is probably ill-chosen; they're only spurious because this is an edge case.
Status => ‘active’
Purpose => ‘discovery’
Created => response creation date
Request: .display => “requested by [name of service or package]”
Outcome => “complete”
Insurer: .display => “Veterans Health Administration”
The only data coming back from the service, which we need to provide, is the classification, and optionally time:
<env:Envelope xmlns:env="http://schemas.xmlsoap.org/soap/envelope/">
<env:Header/>
<env:Body>
<getEESummaryResponse xmlns="http://jaxws.webservices.esr.med.va.gov/schemas">
<eesVersion>5.2.0.01008</eesVersion>
<summary>
<communityCareEligibilityInfo>
<eligibilities>
<eligibility xmlns="">
<vceDescription>Basic</vceDescription>
<vceEffectiveDate>2019-02-25T08:39:33.000-06:00</vceEffectiveDate>
<vceCode>B</vceCode>
</eligibility>
</eligibilities>
</communityCareEligibilityInfo>
</summary>
<invocationDate>2019-03-13T07:18:07</invocationDate>
</getEESummaryResponse>
</env:Body>
</env:Envelope>
Last updated: Apr 12 2022 at 19:14 UTC
