Stream: implementers
Topic: FHIR Interpretation of patient's coverage
Tihomir Petrov (Jan 13 2020 at 09:52):
We have many insurance funds, including a government fund, and we have contracts with each of them for services and supplies for reimbursement.
During the examination, the patient may be billed under a different contract and by a different service, at the end of the examination the amount is formed by the total number of services provided, supplies for the current examination. services and supplies in the context of the review.
In what FHIR structure of resources would you suggest implementing this scheme?
John Moehrke (Jan 13 2020 at 15:08):
not clear what you are needing to persist. Is it Contract resource applicable? Do you need to persist anything other than an identifier to externally managed contract language?
Josh Lamb (Jan 21 2020 at 15:21):
Not sure if this is what you need but there are several financial resources in FHIR R4 (https://www.hl7.org/fhir/financial-module.html). Sounds like the Claim, Coverage, Contract, and ExplantionOfBenefit may be resources to consider.
Varvara (Feb 03 2020 at 12:20):
@Tihomir Petrov hi, coverage in your case covers specific patient, i.e each patient has its own coverage/es?
Last updated: Apr 12 2022 at 19:14 UTC
