Stream: CARIN IG for Blue Button®
Topic: C4BB EOB Professional Profile - ProcedureCode?
Jason Buys (Apr 12 2021 at 17:39):
I am wondering why the profile for C4BB EOB Professional does not contain a procedureCode section, even though it is mentioned as required in the description text, and shows up in the sample files for this profile.
Corey Spears (Apr 13 2021 at 04:16):
The CARIN BB IG reflects the information coming from claims transaction data. From what I understand, professional and non-clinician claims do not include header level procedures. They do include line level procedures which are indicated in the ExplanationOfBenefit.item.prodoctOrService.
@Pat Taylor @Amol Vyas @Pamela Maklari
Jason Buys (Apr 13 2021 at 16:23):
Corey Spears said:
The CARIN BB IG reflects the information coming from claims transaction data. From what I understand, professional and non-clinician claims do not include header level procedures. They do include line level procedures which are indicated in the ExplanationOfBenefit.item.prodoctOrService.
Pat Taylor Amol Vyas Pamela Maklari
I do not see the procedureCode listed at the item level either. item.png
Corey Spears (Apr 13 2021 at 17:20):
That screenshot seems to be from the "Must Support" tab. If you look at the differential or snapshot view, you will see an element called productOrService which includes a procedure code binding.
image.png
Jason Buys (Apr 13 2021 at 18:01):
Right, however what I am wondering is why it shows up on the "Must Support" for the other types, but not for professional? Is it fair to say that if you have a procedure code for a professional claim, that you must publish that data? Thus it would go in the "must support" list?
Last updated: Apr 12 2022 at 19:14 UTC
