Stream: Da Vinci PCT
Topic: Response to Patient
Sam Undine (Nov 18 2021 at 17:13):
Payers providing the AEOB to the patient via FHIR is optional. If payers decide they wish to provide an AEOB via FHIR, in the spirit of reusability, couldn’t the CARIN BB IG be adapted to provide the AEOB? This would allow payers and 3rd party developers to leverage code they defined for the Patient Access API, making adoption of a FHIR API for the AEOB much easier to implement. Coding to the profiles currently defined in the PCT IG will require payers and 3rd party developers to write new code. As a result, adoption could be low.
@Amol Vyas @Pat Taylor @Michael Gould @Ranjith Kandur @Tony Benson @Linda
Larry Decelles (Nov 18 2021 at 23:35):
It is not the same because currently the AEOB in PCT is based on one EOB Resource and CARIN BB is based on four EOB Resources (for different submissions). In the PCT AEOB we are producing it for different reasons. We mostly want adjudication data. We do not need all the claims data elements because it is not a claim.
Regarding your “adapted” question technically it might be possible.
Pat Taylor (Nov 19 2021 at 16:24):
@Larry Decelles The CARIN BB defines two Institutional Profile, a Professional Profile, a Pharmacy Profile and a new Oral Profile. The AEOB use case would use the two Institutional and Professional Profiles. The cardinality of the CARIN BB data elements would need to be reviewed to determine which is applicable. Happy to work with you to evaluate.
Pat Taylor (Nov 19 2021 at 17:17):
@Larry Decelles However, why wouldn't the adjudicated data elements align?
Larry Decelles (Nov 29 2021 at 20:57):
Pat Taylor said:
Larry Decelles However, why wouldn't the adjudicated data elements align?
Hello Pat, I am not saying the adjudication data elements would not align. But as Viet say below if warranted this would require more analysis.
Last updated: Apr 12 2022 at 19:14 UTC
