Stream: financial
Topic: CoverageEligibilityResponse reference to request
Jay Lyle (Jun 07 2021 at 18:27):
We are performing coverage verification and discovery based on patient appointments. The tool performing the operations uses X12, and the response is then put into FHIR resources. When we create a CoverageEligibilityResponse, we find that it requires a reference to the Request, but we don't have that resource. We could impute one, but the information is not used.
In the near term, we think we'd prefer a "light" reference (reference.display = "Insurance capture query") to a DAR, but we would like to hear how others may be dealing with this issue.
In the long term, we wonder if the cardinality constraint might be relaxed.
Lloyd McKenzie (Jun 07 2021 at 20:54):
@Paul Knapp
Lloyd McKenzie (Jun 07 2021 at 20:55):
+1 to this. In general, the FM resources shouldn't be expressed as 'responses' - they should allow for sharing records asserting determinations of eligibility, prior authorization, etc. without requiring that a formal request has been submitted.
Last updated: Apr 12 2022 at 19:14 UTC
