Stream: CARIN IG for Blue Button®
Topic: Absence of eob.total.inoutnetwork on Prof Profile
Caitlin Ryan (Apr 09 2021 at 13:54):
@Corey Spears @Pat Taylor @Amol Vyas @Mark Roberts I see for IP, OP and Rx profiles there is an EOB.total:inoutnetwork slice but it is not in the Prof profile? I know the slice is being renamed in the 1.1.0 release and is not being added to the Prof profile so it is clearly deliberate and my apologies if it is obvious to those more familiar with claims/EOBs but I cannot find the reasoning anywhere. Thanks in advance for the explanation!
Pat Taylor (Apr 09 2021 at 22:32):
@Caitlin Ryan The Benefit Payment Status indicates if a service was paid in or out of network. Institutional and Pharmacy are paid at the claim level. For Professional and Non Clinician, individual lines may be paid as in and out of network. For example, an orthopedist office visit may be paid as in network while crutches may be paid as out of network.
Caitlin Ryan (Apr 13 2021 at 14:08):
@Pat Taylor thank you!
Last updated: Apr 12 2022 at 19:14 UTC
