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This call is at 2:30 PM ET

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    Meeting ID: 933 7214 7617

  Agenda Outline

Recap

                                                                                                                                                            



CARIN Track @ HL7 Connectathon

Status of CARIN BB WG Ballot Reconciliation

Ticket Review (for a full report of the proposed resolutions please refer to the ticket. The full resolutions were not included to conserve space)

NUBC | count = 9 | Block-Vote-3a

  • FHIR-25678 - enumerate NUBC If possible
    • Proposed Resolution: The NUBC Value Sets are defined in each of the tickets listed in related issues. The associated Code Systems are defined as stubs to reference external terminologies once IP issues have been resolved.
  • FHIR-26711 - Define NUBC data elements as an External Code System
    • Proposed Resolution: The code systems defined for the value sets are being defined as stubs, which are external code systems.

CPT / HCPCS | count = 2 | Block-Vote-3c

C4BB Value Sets / Code Systems | Block-Vote-3f | Count = 15

  • FHIR-26992 -Replace CARIN Blue Button Adjudication Amount Category Value Set with Adjudication CARINBB Value Set
  • FHIR-27002 -Replace CARIN Blue Button Adjudication Benefit Payment Status Category Value Set with Payer Benefit Payment Status Value Set
  • FHIR-27003 -Replace CARIN Blue Button Network Contracting Status Value Set with Payer Provider Contracting Status Value Set
  • FHIR-27009 - Define Claim Payment Status Code
    • Proposed Resolution:

      Define Value Set:

       

      Defining URL:http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayerClaimPaymentStatusCode
      Name:C4BBPayerClaimPaymentStatusCode
      Title:C4BBPayer Claim Payment Status Code
      Definition:Indicates whether the claim was paid, denied or if some of the line items were denied
      Copyright:This Value Set is not copyrighted. 
      Logical Definition:This value set includes codes from the following code system:
      ·       Include paid and denied defined in http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayerAdjudicationStatus
      Expansion:This value set contains 3 concepts
      CodeDisplayDefinition
      paidPaidIndicates if the claim was approved for payment
      deniedDeniedIndicates if the claim was denied
      partiallypaidPartially paidIndicates that some line items on the claim were denied


      Bind with binding strength Required to the data element payment.type in all four profiles

      The Code System for this Value Set was defined in FHIR-27002

       
  • FHIR-26723 -Description: Indicates the in network or out of network payment status of the claim
    • Proposed Resolution: The definition of the Value Set and associated Code System will be resolved when FHIR-27002 is completed
  • FHIR-26766 -Pag6 6-7: It would be more efficient to have a network-status extension and use it on .careTeam
    • Proposed Resolution: FHIR-27003 proposes a disposition defining a C4BB value set to indicate the contracting status of the provider.
  • FHIR-27010 -Replace CARIN Blue Button Diagnosis Type Value Set with Payer Diagnosis Type Institutional Value Set
    • Proposed Resolution:

      Delete Value Set CARIN Blue Button Diagnosis Type 

      Replace with the following Value Sets (and the one defined in FHIR-27011):

  • FHIR-27011 -Define Payer Diagnosis Type Professional and Non Clinician Value Set
    •  Proposed Resolution:           

Define Value Set:

 

Defining URL:http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBClaimProfessionalAndNonClinicianDiagnosisType
Name:C4BBClaimProfessionalAndNonClinicianDiagnosisType
Title:C4BB Claim Professional And Non Clinician Diagnosis Type
Definition:Indicates if the professional and non-clinician diagnosis is principal or secondary
Copyright:This Value Set is not copyrighted. 
Logical Definition:This value set includes codes from the following code systems:
·       Include the code principal defined in http://terminology.hl7.org/CodeSystem/ex-diagnosistype
·       Include the code secondary defined in http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBClaimDiagnosisType
Expansion:This value set contains 2 concepts
CodeDisplayDefinition
principalPrincipal DiagnosisThe single medical diagnosis that is most relevant to the patient's chief complaint or need for treatment.
secondarySecondaryRequired when necessary to report additional diagnoses on professional and non-clinician claims

The Code System is the same as the one defined in FHIR-27010

  • FHIR-26773 - Page 11, row 6: Is E Code should not be modeled as 'diagnosis.type=        
    • Proposed Resolution: FHIR-27010 proposes creating a Value Set for inpatient facility claims from a Code System defining several types of diagnosis payers receive on claims.  Resolution of that issue will resolve this issue.  
  • FHIR-27013 - Define CARIN BB Care Team Role Value Sets
    • Proposed Resolution: Delete Value Set CARINBBClaimCareTeamRole           
  • FHIR-27008 -Modify HL7 Payee Type code system descriptions; increase value set binding to required
    • Define Value Set:

       

      Defining URL:http://hl7.org/fhir/us/carin-bb/ValueSet/C4BBPayeeType
      Name:C4BBPayeeType
      Title:C4BB Payee Type
      Definition:Identifies the type of recipient of the adjudication amount; i.e., provider, subscriber, beneficiary or another recipient
      Copyright:This Value Set is not copyrighted. 
      Logical Definition:This value set includes codes from the following code systems:
      ·       Include all codes defined in http://terminology.hl7.org/CodeSystem/payeetype
      ·       Include all codes defined in http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayeeType
      Expansion:This value set contains 4 concepts
      CodeDisplayDefinition
      subscriberSubscriberThe subscriber (policy holder) will be reimbursed.
      providerProviderAny benefit payable will be paid to the provider (Assignment of Benefit).
      otherProviderAny benefit payable will be paid to a third party such as a guarantor.
      beneficiaryBeneficiaryThe beneficiary (patient) will be reimbursed.



      Bind with binding strength Required to the data element payee.type in all profiles


      Define Code System: 

       

      Defining URL:http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBPayeeType
      Name:C4BBPayeeType
      Title:C4BB Payee Type
      Definition:Indicates that a payee type may be a beneficiary 
      Copyright:This Code System is not copyrighted.  
      Content:
      CodeDisplayDefinition
      beneficiaryBeneficiaryThe beneficiary (patient) will be reimbursed.



    • FHIR-26709 - Add values to Related Claim Relationship Codes
      • Proposed Disposition: Instead of adding values to the HL7 Value Set and Code System, define the following Value Set and Code System

Next Steps

We will review FHIR-28482 and FHIR-28532 during the FM WG call tomorrow, then submit block votes 3a, 3c, and 3f for vote next Tuesday.




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