Stream: implementers
Topic: Guarantors, subscribers, and Coverage
Brendan Keeler (Dec 02 2021 at 15:08):
Looking a bit at the CDA section 2.16.840.1.113883.1.11.10416. Is Guarantor conceptually equal to Coverage.policyHolder or Coverage.subscriber? I know that Account has Guarantor better defined, but if I'm just generating Coverages, where is the right place to put it?
Brendan Keeler (Dec 02 2021 at 15:20):
It would seem:
performer.assignedEntity.code = PAYOR is the payor
performer.assignedEntity.code = GUAR means guarantor, which I think is Coverage.policyHolder
participant.TypeCode = HLD means Coverage.subscriber
participant.TypeCode = COV means covered party member, which means Coverage.beneficiary
Brendan Keeler (Dec 02 2021 at 15:20):
Which is confusing if so, since HLD is so close to holder
Vassil Peytchev (Dec 02 2021 at 16:27):
Guarantor has to support an organization, so it has to be Coverage.policyHolder. I think you are seeing (and suffering) the evolution of the Guarantor concept from HL7 v2.x (GT1 segment) to HL7 V3 (and therefore CDA) to FHIR.
Cooper Thompson (Dec 02 2021 at 17:47):
I don't think Guarantor can be Coverage.policyHolder. You can have account guarantors for things that don't have Coverage. I'm not really familiar with CDA, but it seems odd to have guarantor in Coverage.
Brendan Keeler (Dec 02 2021 at 18:07):
This CDA section is specifically listing coverages, so while guarantors are a superset (i.e. aren't always tied to a coverage), perhaps in this context, they always are the coverage policy holder?
Last updated: Apr 12 2022 at 19:14 UTC
