FHIR Chat · Total vs. adjudication · CARIN IG for Blue Button®

Stream: CARIN IG for Blue Button®

Topic: Total vs. adjudication

Melanie Davies (Sep 10 2020 at 14:57):

In the EOB profiles, what is the difference between "total" compared to "adjudication" (not item.adjudication). Both are at the level of the EOB (not the item) and have a slice for "adjudicationamountype" with "amount" cardinality 1.1.

jason chow (Oct 15 2020 at 18:33):

can anyone address this question? The models are essentially the same except for the reason and value properties on elements of adjudication.
the descriptions in the guide don't do much to differentiate between them. Is it acceptable to simply duplicate the amounts between the two for a given adjudication type?

jason chow (Oct 22 2020 at 20:09):

@Pat Taylor would you be able to explain the difference between total and adjudication at the EoB header level?

Saul Kravitz (Oct 23 2020 at 19:27):

@jason chow Does this address your question? https://build.fhir.org/ig/HL7/carin-bb/branches/v0.1.8/StructureDefinition-C4BB-ExplanationOfBenefit-Inpatient-Institutional.html#notes-on-fields

@Pat Taylor

jason chow (Oct 23 2020 at 19:34):

i saw that yesterday. If you're referring to the statement "populate only if item.adjudication is not available", then i guess so. However that conflicts with the cardinality of the property. I guess the format of the IG doesn't enable accurately describing the relationship between eob.adjudication and eob.item.adjudication.
Would that be an accurate interpretation? @Saul Kravitz

Saul Kravitz (Oct 23 2020 at 20:06):

@jason chow I'll take your answer as a "no" :smile: We (actually @Pat Taylor ) added the documentation with the intent of illuminating such questions, so thanks for the feedback.