Stream: CARIN IG for Blue Button®
Topic: Creating realistic examples
Josh Mandel (Aug 01 2019 at 16:23):
Without a set of worked examples it's very difficult for me to understand what's going on. I wonder if we can collect EOBs in their current form to represent various inpatient, outpatient, and pharmacy claims? I can start by sharing https://github.com/jmandel/my-health-data/blob/master/my-data/EOB-redacted.pdf which represents physical therapy from my ankle sprain last fall; the clinical note + FHIR resources for the visit are also in that repo for correlation. @Amol Vyas (Cambia) can we think about how this would look when represented according to the CARIN BB guide?
Amol Vyas (Aug 14 2019 at 16:00):
@Josh Mandel, thanks for sharing your record. We are currently working to create example instances for the (specific) profiles on the IG and will make them available from the IG. I will update here as soon as we have one available.
Blake Schwendiman (Sep 04 2019 at 22:27):
I will also be very excited to see some real-world examples and will share data if necessary to help in this effort.
Dan Gottlieb (Sep 10 2019 at 16:43):
I'd like to better understand how the financial resources work and since I have no experience with claims or EOB data, as an exercise, I tried to convert the EOB @Josh Mandel posted earlier in this thread to the Carin BB profile.
Dan Gottlieb (Sep 10 2019 at 16:43):
I posted my preliminary efforts at: https://github.com/gotdan/FHIR-Financial-Examples/blob/master/josh-eob.txt
Dan Gottlieb (Sep 10 2019 at 16:43):
One thing that jumped out at me is that the Carin profile removes the processNote element, but retains the noteNumber element, so unless I'm misunderstanding, it seems like there's nowhere to include the text of the notes themselves?
Dan Gottlieb (Sep 10 2019 at 16:43):
Can someone with more knowledge of the space take a look and offer suggestions/corrections?
Dan Gottlieb (Sep 10 2019 at 16:44):
Also, does anyone want to collaborate on building out examples for some common Claim/EOB scenarios in Atlanta this weekend (I'm hoping to spend at least part of the connectathon focused on the BB track)? @Blake Schwendiman ?
Blake Schwendiman (Sep 10 2019 at 18:56):
I'll only be available on Saturday, but I would love to connect and see what we can do!
Michele Mottini (Sep 11 2019 at 14:07):
CMS published test data some years ago: https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/SynPUFs/DE_Syn_PUF.html
Michele Mottini (Sep 11 2019 at 14:28):
We'll probably have a stab at importing in our system - that then renders it as FHIR
Dan Gottlieb (Sep 11 2019 at 15:26):
@Blake Schwendiman Sounds good!
Dan Gottlieb (Sep 11 2019 at 15:28):
@Michele Mottini Thanks for that link - the CMS synthetic data looks like a great resource to explore. I'm also very interested to see the FHIR output from your system if you get it working.
Michele Mottini (Sep 11 2019 at 15:39):
We'll have something up for this week end but with very limited data - couple of weeks at least to have that data set imported
Paul Church (Sep 11 2019 at 16:06):
Do you have a published mapping from DE-SynPUF to FHIR, or just private? I've done some work with synpuf in OMOP, which is nice because of all the work OHDSI has done on mapping it.
Josh Mandel (Sep 11 2019 at 16:23):
"We'll just stack that up with http://omoponfhir.org/".
Josh Mandel (Sep 11 2019 at 16:23):
I wish data mapping worked this way :-)
Josh Mandel (Sep 11 2019 at 16:24):
(In reality, the mismatches/impedance at each step of a multi-step mapping process tend to add up very quickly.)
Paul Church (Sep 11 2019 at 16:29):
Also, GT started that project with clinical resources - I don't think they've done any Coverage/EoB mappings at all.
Josh Mandel (Sep 11 2019 at 16:53):
Indeed.
Ryan Howells (Sep 11 2019 at 17:04):
We should have more information in the next couple of days related to the loading of the test data. John Kelly from Edifecs is loading BCBS of FL and BCBS of TN data. I'm meeting with a number of other Blues plans today to discuss their plans for participation. Patrick Murta from Humana may also have some test data available.
Ryan Howells (Sep 11 2019 at 17:04):
We will be coordinating the activities for the CARIN Blue Button track onsite during a connectathon planning session we'll have in Atlanta for both CARIN implementation guides on Saturday, September 14th from 9am – 10am in Rooms M104 and M105. All are welcome to attend.
Michele Mottini (Sep 11 2019 at 17:31):
@Paul Church no - we'll map to our internal data model, not directly to FHIR
Dan Gottlieb (Sep 11 2019 at 17:46):
@Ryan Howells Looking forward to the session on Saturday. Also, can someone involved with Carin BB effort take a quick look at the mapping issues I ran into? The comments are inlined at https://github.com/gotdan/FHIR-Financial-Examples/blob/master/josh-eob.txt .
Ryan Howells (Sep 11 2019 at 18:22):
Hoping @Amol Vyas can respond once he is back from PTO. @Lisa Nelson may also be able to weigh in.
Ryan Howells (Sep 11 2019 at 18:23):
If not, we will get you some answers this weekend. Thanks for your support!
Michele Mottini (Sep 11 2019 at 22:21):
Latest version of our test server is up at https://fhir.careevolution.com/Master.Adapter1.WebClient/api/fhir-r4 - it has some explanation of benefit data - see for example patient d4b1d050-584f-4797-a9c7-ab72e4cd4452
Michele Mottini (Sep 11 2019 at 22:21):
Login CEPatient / CEPatient2018
Michele Mottini (Sep 11 2019 at 22:21):
If you want a provider login let me know your email and I'll create one for you
Ryan Howells (Sep 14 2019 at 17:54):
Ryan Howells Looking forward to the session on Saturday. Also, can someone involved with Carin BB effort take a quick look at the mapping issues I ran into? The comments are inlined at https://github.com/gotdan/FHIR-Financial-Examples/blob/master/josh-eob.txt .
Hey @Dan Gottlieb - We have real EOB instances in a sandbox that should address your questions. If not, stop by Table 4 and chat with @Amol Vyas
Dan Gottlieb (Sep 14 2019 at 18:43):
Thanks @Ryan Howells ! What's the connection information for that sandbox - is it one of the ones listed on the track spreadsheet?
Ryan Howells (Sep 14 2019 at 18:45):
Thanks Ryan Howells ! What's the connection for that sandbox - is it one of the ones listed on the track spreadsheet?
@Clay Graham can you help?
Clay Graham (Sep 14 2019 at 19:02):
Hey Dan, are you on the floor. I am at Table 4
Dan Gottlieb (Sep 14 2019 at 19:07):
I'm at a breakout, but can swing by at 4pm
Clay Graham (Sep 14 2019 at 19:08):
If you give me your email addr I can send you the implementation guide
Josh Mandel (Sep 15 2019 at 13:15):
I'm struggling a bit with access across the various servers in the spreadsheet. For the next connectathon: as long as we're focused on data profiles and mapping, I'd suggest we should focus on open servers or even just sharing small sets of resources in github.
Josh Mandel (Sep 15 2019 at 13:21):
Thanks to Edifecs team for clear docs. I used these to fetch all EOBs -- which is a set of two, which I've posted at https://gist.github.com/jmandel/7c9f58bc46cd2beb6ecbc4e6772719a0.
Josh Mandel (Sep 15 2019 at 13:22):
Questions for the Edifecs team: the EoBs in your server seem to use https://bluebutton.cms.gov/assets/ig/StructureDefinition extensions, so they're a bit like current CMS BB resources rather than CARIN BB resources? But at the same time, they're based on FHIR r4 rather than STU3. Is there a write-up on how these are modeled?
Josh Mandel (Sep 15 2019 at 13:33):
Other servers from the spreadsheet:
- Humana -- I see participation listed but not a server URL. Is this documented somewhere?
- Cambia -- I see "the caller must first get a JWT token using the clientId/secert for the account." but I'm not sure if this is a static token, of I'm supposed to write a program to request one? I see several entries like "ABC: ..." but don't know what they mean.
- AaNeel Infotech -- I see "JWT based token, Identity Server 4 with .Net core with Client Secret as: auth_web/secret" but don't know what this means in practical terms -- is there a token I can use, or how do I get one?
- CareEvolution -- I got access and added the EOB results (3 of them) to https://gist.github.com/jmandel/7c9f58bc46cd2beb6ecbc4e6772719a0. Note that a query sans
?patient=hangs for 30s and then fails with Queried 1003 items without finding a valid one, please use more restrictive criteria in a stack trace. I wonder if it's possible to fail faster.
Josh Mandel (Sep 15 2019 at 13:35):
From the careevolution payload: this is a heck of a status -- I would have expected to see something like "active" rather than a claim status like "paid". @Michele Mottini can you share your thinking on this?
Paul Church (Sep 15 2019 at 13:52):
FYI for clients - I've updated the Google server info on the spreadsheet, it's now an R4 server behind a proxy that does oauth2.
Michele Mottini (Sep 15 2019 at 13:55):
@Josh Mandel : yes, bad error - it is due to having a ton of (mostly bad) EOBs in that server, that the patient cannot access - it has access only to his own. In a production server we would disable the search without specifying a patient ID, so you would get back a 400 immediately
Michele Mottini (Sep 15 2019 at 13:56):
Re. the status: what we have is claim data - that we are mapping to ExlanationOfBenefit. This is not an artifact of our test server: all our customers have claim data, not ExplanationOfBenefits
Clay Graham (Sep 15 2019 at 14:18):
@Josh Mandel if you are on the floor we are at table 4. I can explain the ABC and HSQD payer credentials and how they map to the payer client code. They represent different "personas", we don't have OAUTH2 personas yet so we are using a Basic JWT Auth flow with separate client credentials.
Josh Mandel (Sep 15 2019 at 15:40):
Thanks @Clay Graham. Dan helped me get access to some examples. Looking at https://github.com/gotdan/FHIR-Financial-Examples/blob/master/cambia-healthsparq-eob.json#L92-L96 this identifier seems to use a non-existing system from a CARIN namespace (http://hl7.org/fhir/us/carin/CodeSystem/carin-bb-claim-type) which is problematic, because it implies that identifier values would be globally scoped -- whereas in reality, each organization needs to maintain its own identifier system to make sure IDs don't overlap.
Josh Mandel (Sep 15 2019 at 15:45):
Also, making sure I'm reading this right -- does this represent a claim paid out to a patient?
Clay Graham (Sep 15 2019 at 18:17):
Also, making sure I'm reading this right -- does this represent a claim paid out to a patient?
On that it looks like the payee is the patient, not sure if this is correct I would expect it to be the practitioner.
Josh Mandel (Sep 15 2019 at 19:15):
OK, thanks; that's kind of what I was wondering. Looks like maybe an error in the sample.
Michele Mottini (Sep 18 2019 at 15:13):
@Josh Mandel fixed permissions on our server, now patients (like the CEPatient login) have to specify a patient ID in all searches
Michele Mottini (Sep 30 2019 at 16:32):
We imported some of the CMS synthetic data (https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/SynPUFs/DE_Syn_PUF.html) in our sandbox (https://fhir.careevolution.com/Master.Adapter1.WebClient/fhir) - 100 patients, around 100,000 explanation of benefits
Michele Mottini (Sep 30 2019 at 16:33):
There are three logins corresponding to three of those patients - CMSPatient1, CMSPatient2, CMSPatient3 - password the same as the user name
Michele Mottini (Sep 30 2019 at 16:34):
Patient IDs 5bd3e5c5-af24-4463-98a9-b8918bef1747, 3378a64a-730c-47e1-9568-fa7be66487b7, 359bdfe5-53e3-4b77-9a47-2ba6a261a5e8
Michele Mottini (Sep 30 2019 at 16:37):
If you have a provider logins on our sandbox you can see all the data at https://fhir.careevolution.com/Master.Adapter1.WebClient/fhir/search?prefix=fhir-r4 searching for ExplanationOfBenefit with patient.identiifer=http://fhir.carevolution.com/identifiers/CareEvolution/MRN/cms-synthetic|
Michele Mottini (Sep 30 2019 at 16:37):
Or get a token at https://fhir.careevolution.com/Master.Adapter1.WebClient/oauthtest/oauthtest.html and then use it to access the FHIR end point directly, or use your own SMART app
Last updated: Apr 12 2022 at 19:14 UTC
