Stream: CARIN IG for Blue Button®
Topic: 0.1.6 Build
Josh Lamb (Oct 14 2020 at 13:38):
Hello @Saul Kravitz and @Pat Taylor ,
I am getting a validation error when I omit EOB.adjudication (header level) for outpatient institutional and inpatient institutional.
Error message:
"severity" : "error",
"code" : "structure",
"details" : {
"text" : "Profile http://hl7.org/fhir/us/carin-bb/StructureDefinition/C4BB-ExplanationOfBenefit-Outpatient-Institutional, Element 'Bundle.entry[3].resource.ofType(ExplanationOfBenefit).adjudication[adjudicationamounttype]': minimum required = 1, but only found 0"
Josh Lamb (Oct 15 2020 at 20:13):
Upon review, the error makes perfect sense. Inpatient/outpatient profiles have EOB.adjudication as '1..*'.
I believe this should be '0..*' as the intent of the header level adjudication seems to be to capture the header level denial reason. @Pat Taylor, Can you help clarify the intent of the EOB.Adjudication requirement on inpatient/outpatient?
Pat Taylor (Oct 16 2020 at 16:15):
@josh lamb The rule is that item.adjudication should be populated if the data is available. If data is not available, then the leader level adjudication should be populated. To your point, the cardinality should be 0..*. However, I would like to define an invariant requiring one or the other. Your thoughts?
Josh Lamb (Oct 16 2020 at 16:32):
My suggestion, for both inpatient and outpatient, is to set EOB.Adjudication to '0..x' and EOB.Item.Adjudication to '0..x'. I would keep EOB.Total (which also holds header level adjudication amounts) as '1..x'
I am not sure if you could set an additional requirement that the sum of EOB.Adjudication and EOB.Item.Adjudication slices must be at least '1..x'. Actually, is your requirement that every single EOB.Item.Adjudication have at least one slice populated -OR- EOB.Adjudication have at least one slice populated? This seems very tricky to enforce.
Last updated: Apr 12 2022 at 19:14 UTC
