Stream: implementers
Topic: Max out of pocket
Aron Kohn (Aug 28 2019 at 20:34):
Hi all,
Where can we record the remaining value for maximum out of pocket on the eligibility response? Should we add another value to the BenefitTypeCodes value set? http://build.fhir.org/valueset-benefit-type.html
The thing is that this gets more complicated when there's multiple max out of pockets for family and individual.
What are your thoughts?
Lloyd McKenzie (Aug 28 2019 at 20:39):
@Paul Knapp @Andy Stechishin
Paul Knapp (Aug 29 2019 at 18:33):
@Aron Kohn @Andy Stechishin The valueset provided is simple and example, I expect you would want to use the conventional valueset and Code System for your market, in which case you may or may not need to add the code for maximum out of pocket.
Given that a separate entry for individual and family can be provided I think you can safely use the same code on separate entries to express that the individual maximum could be, for example, $500 and for the family be $1800.
Aron Kohn (Aug 29 2019 at 19:01):
Thanks for the clarification @Paul Knapp I didn't realize that the binding is "Example".
Last updated: Apr 12 2022 at 19:14 UTC
