Stream: CARIN IG for Blue Button®
Topic: EOB.party Need to Reference an Organization
Joel Hansen (Aetna) (Jun 23 2020 at 16:30):
Hi everybody,
Question about the EOB Base IG....
For the attribute EOB.payee.party (Recipient of benefits payable) the IG is looking for references to either a PractitionerRole or Patient. Excerpt: "CARIN Blue Button Practitioner Role Profile | CARIN Blue Button Patient Profile)
Why was organization not included as a possible reference? We're looking at the scenario where a payment was made to an organization such as a hospital, rather than a specific provider or to the patient.
Thanks in advance,
Joel
Igor Sirkovich (Jun 24 2020 at 05:16):
@Joel Hansen (Aetna), PractitionerRole can point to either Practitioner or Organization or both.
Amol Vyas (Jun 24 2020 at 09:24):
Hi @Joel Hansen (Aetna)
The EOB.payee.party can be either of CARINBBPractitionerRole or CARINBBPatient.
For your need, I believe you would use CARINBBPractitionerRole.
The CARINBBPractitionerRole profile (based on the US Core PractitionerRole profile) contains (and requires) both US Core Practitioner (will be CARINBBPractitioner in the latest IG update) and CARINBBOrganization.
In this case, EOB.payee.party.CARINBBPractionerRole.CARINBBPractitioner.{identifier, name} and EOB.payee.party.CARINBBPractionerRole.CARINBBOrganization.{active, name} will need to be populated at a minimum.
Does that serve your scenario’s need regarding EOB.payee.party?
Joel Hansen (Aetna) (Jun 24 2020 at 13:00):
@Amol Vyas @Igor Sirkovich Thank you both for the replies! I'll follow up with the team and see if using the PractitionerRole to encapsulate the Organization will work.
Joel Hansen (Aetna) (Jun 29 2020 at 17:03):
Hi @Amol Vyas , @Igor Sirkovich
I checked with the team and it sounds like frequently the payment is to an Organization and there is not any accompanying individual practitioner name.
Since, like Amol mentioned above, PractitionerRole now requires references to both US Core Practitioner AND Organization; what do we do in the case where we pay an Organization that does not have an individual Practitioner?
Thanks
Joel
Igor Sirkovich (Jul 02 2020 at 03:18):
@Pat Taylor @Amol Vyas @Saul Kravitz, I believe this should be discussed by the group.
Joel Hansen (Aetna) (Jul 08 2020 at 15:06):
@Igor Sirkovich Thank you for taking up this issue. Let me know if you need any details from me or if there is a session I should attend.
Joel Hansen (Aetna) (Jul 15 2020 at 20:54):
@Igor Sirkovich Just checking if you reviewed this question at all. We're currently hung up when trying to generate EOB.payee.party for just an Organization since the reference is to PractitionerRole which now requires Organization and Practitioner. Is it allowable to, in the case of an Organization, build Practitioner just as a display with the Organization name and build the reference to Organization?
Kate Dech (Jul 15 2020 at 22:48):
@Joel Hansen (Aetna) : I also see this a problem for Pharmacy EOBs when we pay the provider. We represent the Pharmacy as an organization under eob.provider. So we are also curious about Payee being Practitioner Role. According to the CPCDS Data mapping for Practitioner Role, the Organization is to be contained within that Practitioner Role. Yet, there should already be a primary resource available for this Organization.
FYI - @Bapi Behera
Igor Sirkovich (Jul 15 2020 at 22:53):
@Joel Hansen (Aetna), @Kate Dech, we plan to make change in the profile to allow an Organization as a payee. I believe we still need a final approval for this change though.
Last updated: Apr 12 2022 at 19:14 UTC
