FHIR Chat · Care Teams and kinda-synonymous identifiers · CARIN IG for Blue Button®

Stream: CARIN IG for Blue Button®

Topic: Care Teams and kinda-synonymous identifiers

view this post on Zulip Karl M. Davis (Nov 18 2020 at 22:05):

:wave: Howdy, friendly CARIN and FHIR folks. I'm staring at a chunk of our (CMS Blue Button) data schema and mapping and also the CARIN IG and kinda' just... stumped. Maybe someone here can help. Here's what we've got:

  1. At the line/item level in our claims, we have a bunch of identifiers in the raw data that are probably all "synonyms" for each other, or at least related to each other: PRF_PHYSN_NPI, PRF_PHYSN_UPIN, CARR_PRFRNG_PIN_NUM, then ORG_NPI_NUM, and then TAX_NUM.
  2. We also have a bunch of fields _related_ to those, e.g. PRVDR_STATE_CD, PRVDR_SPCLTY, etc.
  3. Right now, we're almost certainly doing the wrong thing: mapping PRF_PHYSN_NPI when it's present to an EOB.careTeam entry that's just a Reference.identifier and then hanging most everything else off of it as an extension.
  4. We do not have a reliable, canonical source of provider data accessible to us right now that we can trust matches the data in the claims.

I'm thinking that this approach will need to shift in a future (backwards incompatible) version of our API, but I'm not entirely sure what the right approach would be. Data at scale is messy, and so we can't really rely on any one of those fields to always be present, or for any particular combo of them to be. We need a mapping solution that works both when the only thing present is PRF_PHYSN_UPIN, or the only thing present is TAX_NUM, or when all of the fields are present.

Right now my best idea is that we should be mapping these to EOB.careTeam entries that are instead contained Practitioner and/or Organization resources. Except TAX_NUM -- we have no way of knowing if that refers to a person or to an org, and so it'll probably have to be mapped to a separate EOB.careTeam entry that's just a Reference.identifier. So: any one line item might refer to three separate EOB.careTeam entries.

Does that all sound kinda' sorta' right or does someone have a simpler approach?

view this post on Zulip Ryan Howells (Dec 01 2020 at 00:47):

Hey @Karl M. Davis our friendly CMS friend. ;) Since this sounds like it's specific to CMS, my suggestion is for @Mark Roberts to invite you to attend one of our upcoming small group IG development calls with @Amol Vyas @Pat Taylor @josh lamb @Saul Kravitz and others so we can brainstorm the best approach here. We can then bring a draft solution back to the broader HL7 community through our public CARIN calls and via this chat to get their thoughts on a suggested approach. Will that work?

view this post on Zulip MaryKay McDaniel (Dec 03 2020 at 17:08):

Karl,

What you are looking at are the additional identifiers for the provider that is being referenced that come in on claims. Some are from Prior to NPI and others are still 'allowed' within the claim.

At the claim line (for Inpatient Claims) there can be an Operating Physician, Other Operating Physician, Rendering Provider, Referring Provider.
For each referenced provider you can have: NPI, State License Number (thus state identifier needed), Provider UPIN, Location Number, and Provider Commercial Number. Tax IDs at the line level are no longer allowed (with the 5010 at least). Only a billing provider or pay to provider now has a tax id.

Others are elements required by Medicare for editing during adjudication - State Code and billing/attending provider Specialty

There are a lot of things you 'could' do here. Could 'derive' orgaznization/practitioner from the claim type or specialty. Does the EOB really need the Tax ID of the operating surgeon from 5 years ago?

And I agree with Ryan, an overall industry approach would be helpful - Medicare won't be the only payer with this issue!

view this post on Zulip Pat Taylor (Dec 04 2020 at 16:21):

Hi @Karl M. Davis . Is the list you provided your complete lists or examples? I have some preliminary thoughts on how some of these could be mapped. @Ryan Howells @Amol Vyas @josh lamb @Saul Kravitz

view this post on Zulip Ryan Howells (Dec 15 2020 at 15:55):

We're on it! Our smaller team will work with @Karl M. Davis to develop a draft approach and we'll present it on our HL7 CARIN calls in January for those who are interested in weighing in.

view this post on Zulip Karl M. Davis (Dec 15 2020 at 17:57):

I need a Zulip remind me bot to yell at me about this next week. Right now, we have an internal meeting scheduled to brainstorm approaches for later this week, though with illnesses and weather and all that I suspect it’s going to get postponed until early next year.

Last updated: Apr 12 2022 at 19:14 UTC


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