Stream: CARIN IG for Blue Button®
Topic: EOB.outcome
Chetana Nayyar (Feb 12 2021 at 11:30):
In context to CMS does the EOB resource stores only the adjudicated claims; if so then how are the rest of the code valueset being used of element EOB.outcome
http://hl7.org/fhir/R4/valueset-remittance-outcome.html
The other context which comes in is the valueset is being pinted to remittance so is the outcome column being used instead for payment process status from the payer?
reference: https://chat.fhir.org/#narrow/stream/246287-CARIN-BB.20ExplanationOfBenefit/topic/EOB.2Eoutcome
Corey Spears (Feb 12 2021 at 18:39):
In the context of the CMS Patient Access API for which the CARIN for Blue Button IG is used, the requirement is that adjudicated claims be made available. While the IG states that the expected code supplied would be "complete", it does not restrict the use of other outcome codes. This means it is possible to also provide claims that have a different outcome.
Saul Kravitz (Feb 15 2021 at 23:23):
The notes say ".outcome: value = complete"
Perhaps the profile and the comment should be made consistent?
Corey Spears (Feb 16 2021 at 00:06):
I agree. There are 3 different expressions between the element binding, the element comments and the notes. The only one of these three that get validated is the element binding. I have noticed some inconsistencies between the notes, the original mapping, and what was in STU1. I imagine this may have been due to changes over time. In preparation for STU2 I am doing a full review and will address these with the project team.
Corey Spears (Feb 19 2021 at 15:35):
After following up with the CARIN BB team, the intent for STU1 was to keep this open with guidance of the usual case (outcome = complete), but after some deliberation, there is an intent to restrict this to completed claims only in STU2.
Last updated: Apr 12 2022 at 19:14 UTC
