2020-09-17 CARIN IG for Blue Button® Ballot Reconciliation Meeting

Dental and Vision Update

• Dental mapping will be ready for review during the 9/24 call

Examples Update

• We will incorporate all the great work done on Examples at the Connectathon into the IG

Status of CARIN BB WG Ballot Reconciliation

• On Monday's call we reviewed tickets in Block-Vote-3a, 3c, and most of 3f
• Today we reviewed two of the three remaining tickets in 3f

  • FHIR-27013 - Define CARIN BB Care Team Role Value Sets

    • We will hold pending confirmation by David Riddle and Gail Kocher

  • FHIR-28482 - Define a Value Set to be used as the discriminator for supportingInfo

  • Proposed Disposition:

    • Define Value Set:

       

      Defining URL:	http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBSupportingInfoType
      Name:	C4BBSupportingInfoType
      Title:	C4BB Supporting Info Type
      Definition:	Used as the discriminator for the types of supporting information
      Copyright:	This Value Set is not copyrighted.
      Logical Definition:	This value set includes all codes from the following code systems: ·       Include all codes defined in http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType

      
      

      
      

      This Value Set is a discriminator for supportingInfo slices.  Binding to a data element is not required. 

      Define Code System: 

       

      Defining URL:	http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBSupportingInfoType
      Name:	C4BBSupportingInfoType
      Title:	C4BB Supporting Info Type
      Definition:	Used as the discriminator for the types of supporting information
      Copyright:	This Code System is not copyrighted.
      Content:
      Code	Display	Definition
      admissionperiod	Admission Period	Dates corresponding with the admission and discharge of the beneficiary to a facility
      pointoforigin	Point Of Origin	UB-04 Source of Admission (FL-15) identifies the place where the patient was identified as needing admission to a facility.
      admtype	Admission Type	UB-04 Priority of the admission (FL-14) indicates, for example, an admission type of elective indicates that the patient's condition permitted time for medical services to be scheduled.
      billingnetworkcontractingstatus	Billing Network Contracting Status	Indicates that the Billing Provider has a contract with the Payer as of the effective date of service or admission.
      brandgenericcode	Brand Generic Code	NCPDP code indicating whether the plan adjudicated the claim as a brand or generic drug.
      clmrecvddate	Claim Received Date	Date the claim was received by the payer.
      compoundcode	Compound Code	NCPDP code indicating whether or not the prescription is a compound.
      dawcode	DAW (Dispense As Written) Code	NCPDP code indicating the prescriber's instruction regarding substitution of generic equivalents or order to dispense the specific prescribed medication.
      dayssupply	Days Supply	NCPDP value indicating the Number of days supply of medication dispensed by the pharmacy.
      discharge-status	Discharge Status	UB-04 Discharge Status (FL-17) indicates the patient’s status as of the discharge date for a facility stay.
      drg	DRG	DRG (Diagnosis Related Group), including the code system, the DRG version and the code value
      performingnetworkcontractingstatus	Performing Network Contracting Status	Indicates that the Performing Provider has a contract with the Payer as of the effective date of service or admission.
      refillnum	Refill Number	NCPDP value indicating the number fill of the current dispensed supply (0, 1, 2, etc.)
      rxorigincode	Rx Origin Code	NCPDP code indicating whether the prescription was transmitted as an electronic prescription, by phone, by fax, or as a written paper copy.
      servicefacility	Service Facility	The facility where the service occurred.  Examples include hospitals, nursing homes, laboratories or homeless shelters.
      typeofbill	Type Of Bill	UB-04 Type of Bill (FL-04) provides specific information for payer purposes.

• FHIR-28532 - Define a Code System to discriminate the slicing in the item.adjudication and adjudication fields

  • Proposed Disposition

    • Define Code System:  

      Defining URL:	http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBAdjudicationDiscriminator
      Name:	C4BBAdjudicationDiscriminator
      Title:	C4BB Adjudication Discriminator
      Definition:	Used as the discriminator for the data elements in adjudication and item.adjudication
      Copyright:	This Code System is not copyrighted.
      Content:
      Code	Display	Definition
      allowedunits	allowed units	defines the adjudication slice to define allowed units
      inoutnetwork	in or out network	defines the adjudication and item.adjudication slice to indicate whether a claim was adjudicatd in or out of network
      denialreason	denial reason	defines the adjudication slice to identify the denial reason

      
      

      A value set is not required to constrain the value of adjudication.category and item.adjudication in the abstract profile as it unnecessarily would over constrain its use. 

• Remaining tickets

  • 8 tickets remain to be reviewed and we will look to have these ready for review next week.

  •