Stream: implementers
Topic: ExplanationOfBenefit
Varvara (Apr 02 2018 at 16:09):
Hello, @Paul Knapp ,
Could you please clarify the usage of ExplanationOfBenefit.precedence field: is it related to primary/secondary payer?
I see FHIR EoB has only one ClaimResponse reference, does that mean that we need to create two EoB resources if we have several ClaimResponses for one Claim, for example, in a case when a patient has primary and secondary insurance and two Claim responses, accordingly ? Or is it implied that we only send EoB with the secondary Claim response reference?
Paul Knapp (Apr 03 2018 at 11:19):
Hi @Varvara There would be a separate EOB for each Coverage, so if a patient has both a primary and secondary Coverage then there would be two EOBs - even if the Coverages are both with the same insurer. This is because the EOB is literally an 'explanation of the benefit' provided under the specified coverage for that instance of care.
If you are US based then the Claim is the corollary to the 837 and the ClaimResponse is the 835 (Remittance with acknowledgement or adjudication). The EOB combines the Claim and ClaimResponse and drops any provider-insurer private information and so is suitable for sharing with the Patient (eg. BlueButton) and others, and as a reporting mechanism.
Varvara (Apr 03 2018 at 12:05):
Thank you for clarifying that, @Paul Knapp !
Paul Knapp (Apr 03 2018 at 12:07):
@Varvara You are welcome. The Financial Management (FM) work group meets Thursdays at 2 Eastern if you would care to join, share ideas and questions.
Varvara (Apr 03 2018 at 13:43):
Thank you, @Paul Knapp , sure I'll be glad to participate, is it online conference? Could you please provide a link if so ?
Paul Knapp (Apr 04 2018 at 06:50):
@Varvara http://www.hl7.org/concalls/Default.aspx?ref=nav is the link to the HL7 conference calls, you can set up an account through the HL7 web site at no cost, then join the FM list serve as well.
This weeks call is cancelled but normally:
Call is scheduled to last 1 hour
Thursday 02:00-03:00 PM (Eastern Time, GMT -04 DST)
Please consult http://www.timeanddate.com/worldclock for your local times
This is a call in a recurring sequence (and occurs every week).
Participation Information: audio and screen sharing
Web Meeting Info
https://join.freeconferencecall.com/fm4
Nishant Thakkar (Jan 10 2020 at 12:44):
How to perform search on "servicedDate" field for STU3 EOB resource?
For the testing purpose I am using fire.ly server.
pasted image
Nishant Thakkar (Jan 10 2020 at 12:55):
How to search on "BillablePeriod" as well?
Lloyd McKenzie (Jan 10 2020 at 15:53):
Those aren't standard search criteria for the resource. If you think they should be, feel free to submit a change request to have search parameters added for R5 and beyond. In the meantime, you'd have to define custom SearchParameter instances and then configure your server to support those custom parameters.
Nishant Thakkar (Jan 13 2020 at 07:00):
@Lloyd McKenzie thank you
Nishant Thakkar (Jan 17 2020 at 14:07):
How to search with Reference type? I have applied Patient Reference search against EOB resource on vonk server STU3, but results are not as per expectation. Below is the screenshot of the same.
pasted image
René Spronk (Jan 17 2020 at 14:37):
'reference' is not a valid search parameter name for the EOB resource, see http://build.fhir.org/explanationofbenefit.html#search , you'd need patient
Nishant Thakkar (Jan 17 2020 at 14:47):
@René Spronk I am beginner, so I don't know how to search it, can you please provide sample for the same.
I have gone through the URL mentioned by you. But over there also reference is provided in search parameter.
Thanks in advance.
Michele Mottini (Jan 17 2020 at 15:00):
The parameter name should be 'patient' instead of 'reference'
Igor Sirkovich (Jan 17 2020 at 15:31):
@Nishant Thakkar, for a search you need to use a search parameter Name, not the Type. If you are a beginner , I would suggest to read at the minimum the following 2 pages before you start playing with FHIR: https://www.hl7.org/fhir/search.html and https://www.hl7.org/fhir/http.html
Nishant Thakkar (Jan 17 2020 at 15:36):
Nishant Thakkar, for a search you need to use a search parameter Name, not the Type. If you are a beginner , I would suggest to read at the minimum the following 2 pages before you start playing with FHIR: https://www.hl7.org/fhir/search.html and https://www.hl7.org/fhir/http.html
Thank you, it worked for me.
The parameter name should be 'patient' instead of 'reference'
sure.
Venkat (Jun 29 2020 at 16:20):
Hi Team,
I am new to FHIR, Currently I am using FHIR version R4 (4.0.1) and HAPIFHIR (4.1.0). I need to achieve the attached JSON format of ExplanationOfBenefit resource (Especially looking at Contained). I do have below questions on this.
- When I add Patient resource without setting ID it is getting added to Contained with generated Id as 1 is there any way to generate id as "Patient/1"?
- I am trying to add other resources like RelatedPerson, Organization etc.,to contained without setting the id to these resources. But I am not successful, not sure whether we can add these resources to Contained of Explanation?
Could you please help me on this, if possible please share a code snippet.
Mareike Przysucha (Jun 29 2020 at 16:23):
Hi @Venkat. Welcome to zulip. You probably want to create a new thread in this stream as this stream deals with ConditionDefinition. When you create a new message, just change the name of the thread (the second input next to "implementers"). Thank you and I wish you helpful answers.
Lloyd McKenzie (Jun 29 2020 at 22:10):
I moved the post to the correct thread make it easier for others to find.
Lloyd McKenzie (Jun 29 2020 at 22:20):
@Venkat:
-
"id" isn't allowed to contain upper-case alphas or "/". Why do you want the id to be 'Patient/1'?
1a) Why are you trying to have the Patient contained at all? 'contained' isn't a handy mechanism for packaging a bunch of resources together, it's for sending resources that have no independent existence and can't exist without the container. That wouldn't generally make any sense for Patient with an EOB -
First, make sure that 'contained' is actually appropriate. Second, you have to have an id for all contained resources - and those contained resources must be referenced either by the container or by other contained resources
Venkat (Jul 09 2020 at 05:35):
Hi Team,
If possible could you please share a FHIR JSON with ExplanationOfBenefit resource for reference and for understanding.
Regards,
Venkat.
Igor Sirkovich (Jul 09 2020 at 07:20):
Did you look at https://www.hl7.org/fhir/explanationofbenefit-examples.html ?
Venkat (Jul 09 2020 at 07:35):
Hi Igor,
Thanks for response I am having a look at. one more question I am setting Resource Id as "Patient/1" but in my JSON output I am getting Resource id as "1" only, is there any way to tell HAPi FHIR not to remove the prefix in id?
Thanks in advance,
Venkat.
Lloyd McKenzie (Jul 09 2020 at 13:58):
That might be best asked on #hapi
Lloyd McKenzie (Jul 09 2020 at 13:58):
(And you should share the code you're using to populate the patient element)
Aritra Kundu (Oct 19 2020 at 11:55):
Paul Knapp said:
Hi Varvara There would be a separate EOB for each Coverage, so if a patient has both a primary and secondary Coverage then there would be two EOBs - even if the Coverages are both with the same insurer. This is because the EOB is literally an 'explanation of the benefit' provided under the specified coverage for that instance of care.
If you are US based then the Claim is the corollary to the 837 and the ClaimResponse is the 835 (Remittance with acknowledgement or adjudication). The EOB combines the Claim and ClaimResponse and drops any provider-insurer private information and so is suitable for sharing with the Patient (eg. BlueButton) and others, and as a reporting mechanism.
Hi Paul,
Could you please let me know if I can use EOB profile (CARIN BB) to capture Provider remittances details?
Regards,
Aritra
Last updated: Apr 12 2022 at 19:14 UTC
