Stream: CARIN IG for Blue Button®
Topic: ExplanationOfBenefit.adjudication
John Achoukian (Sep 29 2020 at 23:08):
Is the ExplanationOfBenefit.adjudication resource in C4BBExplanationOfBenefitProfessionalNonClinician (306) incorrect and should it match how it is defined in C4BBExplanationOfBenefitOutpatientInstitutional (311)?
C4BBExplanationOfBenefitProfessionalNonClinician
306. ExplanationOfBenefit.adjudication
Definition
The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
Control 0..*
Type See ExplanationOfBenefit.item.adjudication:allowedunits
Must Support true
Requirements
Some insurers will receive line-items but provide the adjudication only at a summary or header-level.
Invariants Defined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
C4BBExplanationOfBenefitOutpatientInstitutional
311. ExplanationOfBenefit.adjudication
Definition
The adjudication results which are presented at the header level rather than at the line-item or add-item levels.
Control 0..*
Type BackboneElement
Must Support true
Requirements
Some insurers will receive line-items but provide the adjudication only at a summary or header-level.
Invariants Defined on this element
ele-1: All FHIR elements must have a @value or children (: hasValue() or (children().count() > id.count()))
Slicing This element introduces a set of slices on ExplanationOfBenefit.adjudication. The slices are unordered and Closed, and can be differentiated using the following discriminators:
pattern @ category
Saul Kravitz (Sep 30 2020 at 14:23):
They are different by intent. http://build.fhir.org/ig/HL7/carin-bb/EOBProfileComparison%202020%200904.png
John Achoukian (Sep 30 2020 at 17:06):
@Saul Kravitz Thank you for the clarification
Last updated: Apr 12 2022 at 19:14 UTC
