Stream: CARIN IG for Blue Button®
Topic: CARIN EOB and Pre-D's and Pre-Auth's
Joel Hansen (Feb 24 2021 at 21:53):
@Pat Taylor @Amol Vyas @Mark Roberts
Hi Pat, Amol, Mark,
We have some Predeterminations and some Pre-Authorizations in our data set. Per the CARIN IG, EOB.use is required to be CLAIM.
Question: Based on the required pattern of CLAIM, should we exclude Pre-D's and Pre-Auth's from our EOBs? Our assumption is 'Yes".
Thanks
Joel
Corey Spears (Feb 25 2021 at 05:31):
The primary purpose of the CARIN BB is to address the CMS rules regarding patient access API requirements. These rules, where they address patient access, apply to adjudicated claims. So, I would say that your assumption is correct for use of the CARIN IG.
Also since the EOB use has to be claim, I think it would be very confusing to the patient to have predeterminations and pre-authorizations show up as claims.
I am sure @Pat Taylor , @Amol Vyas , and @Mark Roberts can provide more context and history if needed.
Pat Taylor (Feb 25 2021 at 12:57):
@Joel Hansen Hi Joel, Yes, your assumption is accurate; you should not include Pre_Ds and Pre-Auths in the EOB responses. @Corey Spears @Amol Vyas @Mark Roberts
Joel Hansen (Feb 25 2021 at 13:58):
Thanks @Corey Spears and @Pat Taylor for the replies. I appreciate it.
Last updated: Apr 12 2022 at 19:14 UTC
