Stream: CARIN IG for Blue Button®
Topic: EOB status
Courtney Bland (Aug 31 2020 at 17:01):
Good afternoon,
The CMS rule mentions including only adjudicated claims. If we aren't supposed to supply claims that are in progress because they have not entirely finished adjudication, then is anyone using the EOB statuses of draft, entered in error, ect. It seems like active and cancelled would be the only valid values. Am I off base? Thank you for your help.
Karl M. Davis (Aug 31 2020 at 17:04):
FWIW, that's what the CMS BB2 API does. :shrug:
Courtney Bland (Sep 01 2020 at 19:21):
Courtney Bland said:
Good afternoon,
The CMS rule mentions including only adjudicated claims. If we aren't supposed to supply claims that are in progress because they have not entirely finished adjudication, then is anyone using the EOB statuses of draft, entered in error, ect. It seems like active and cancelled would be the only valid values. Am I off base? Thank you for your help.```quote FWIW, that's what the CMS BB2 API does. :shrug:I appreciate the fact that you responded to me. I think my main question is whether there is any reason to use some of those statuses.
Josh Lamb (Sep 02 2020 at 00:19):
The CARIN IG only covers adjudicated claims, which translate to the statuses you indicated (active and cancelled). A payor may choose to include EOBs with other statuses but they would fall outside of scope of the IG. @Pat Taylor for confirmation.
Pat Taylor (Sep 08 2020 at 16:00):
@josh lamb yes, Josh is correct. The IG does not prevent inclusion of EOBs with other statuses but does require provisioning of adjudicated claims.
Last updated: Apr 12 2022 at 19:14 UTC
