PCT GFE Institutional .item, remove .item estimated DOS extension

Institutional profile - modify mapping of charge amount

Professional profile - modify mapping of charge amount

US Core Reference

Terms and concepts - Charge Master Description

Terms and concepts - Collection of Services

Systems Update

Disclaimer wording is awkward in MRI scenario

Remove section 4.4 Testing requirements

In the Coverage profile, remove Must Support from costToBeneficiary

Modify AEOB profile to add Practitioner

Require pattern for AEOB profile claim.use; add MS to claim.status

AEOB profile - remove expirationDate

Remove Must Support from Institutional.facility

Clarify wording for Claim Resource in GFE Bundle Resource

Remove inherited invariants from profile pages

stronger language in P&S section

Terms and concepts - De-identified Minimum Negotiated Rate

PCT AEOB Profile - Add PractitionerRole to provider

Terms and concepts updates - Consolidated Appropriations Act

change SHOULD to SHALL

Terms and concepts updates - Advanced EOB

Downloads

PCT GFE Professional - remove procedure:other slice

Security and Privacy section mentioning X12

Require pattern for professional profile claim.use; add MS to claim.status

Move downloads to its own page with a menu link

Add link to GFE Submit operation in referenced Overview text

Include link to HRex IG in overview

Add link to GFE Submit operation

Define AEOB on first use on page

Update Example

All diagrams should have an identifier to make it easy to reference.

Add definition of GFE

Institutional profile - remove location extension

Clarify a single PCT GFE Bundle SHALL only contain gfe for a single patient

GFE Professional Claim .accident, constrain to locationAddress, add binding to country code

PCT GFE Institutional - .accident, constrain to locationAddress and add binding for country code

edit definition of Changemaster

Require pattern for institutional profile claim.use; add MS to claim.status

Patient Profile - remove employeeID

Define Servicing Facility reference resource as an organization, not a location

Remove PractitionerRole Profile

PCT GFE Institutional supportingInfo:typeOfBill .code

Remove the Location Profile

Remove Code Systems defined for testing purposes

Define Institutional Servicing Facility reference resource as an organization, not a location

More guidance is required for the AEOB Out of network provider info

Provide link to the CAA No Surprises legislation

PCT GFE Institutional - .careTeam:attending - PCT Practitioner only

Payer Intermediary and FHIR-X12 Translators

Move Security section to own page as a Menu item

Professional Profile: Difference between the Provider Event Methodology and the Provider GFE Grouper Methodology

Professional Profile - remove location extension

Make AEOB .benefitPeriod cardinality 1..1

Add markdown datatype to disclaimer extension

AEOB - Add a String Element to contain the Description of the Provided Service

Change AEOB element short description and comments on ExplanationOfBenefit.created

Change GFE Billing Provider Line Item Control Number to item.sequence

use of the term "near real time"

Could payers reasonably produce an AEOB in 5 minutes?

Change terminology for 'Submitting Provider' to 'Convening Provider'

Fixed display values should not generally be required

Practitioner Profile - add NUCC Value Set to .qualification

Remove the Taxonomy extension from Organization

Change the use of payor to payer

Add EOB.use to explanation of predetermination

Correct wording on example regarding occurence of resource

Add missing '$' to FSH alias reference.

Out of Network Info

Modify .provider Reference Resource

PCT Practitioner - Add explicit identifier slice for Tax ID

rewrite in third person

Update the the finally published version of HRex

PCT Coverage - check to ensure is based on HRex - Missing Group Slice in IG

Align PCT Coverage with HRex 1.0.0 Coverage

Update Overview to better reflect the workflow

Stronger language as to why Provider SHOULD also receive AEOB

Overview Flow

should state the close relationship between GFEs/AEOBs and X12 claims/ERAs

Change overview language regarding X12

Institutional profile - supportingInfo:typeOfBill update

Remove Organization.identfier ccn as MS element

In the Organization profile, update the ccn identifier description

Organization Profile - add payer id and NAIC identifiers

References to CAA

Reference to X12

Advanced EOB Response to Provider(s) Must Be Optional

Revise PCT Organization Type Code System

Practitioner Profile - update the ccn identifier description

In the Coverage profile, define slices for .class

GFE Submitter Must be Uniform Across All GFEs within a Bundle

Add invariant requiring only a single GFE submitter

Institutional Profile - add estimated admission period

Define DRG as .supportingInfo on Institutional Profile

Correct overview wording using IG name

"Must Support" is not defined in this IG and it has to be since it is applied to several of the Resources

Organization Profile - delete tin identifier

Remove MS from AEOB.item.revenue

FHIR US Core 3.1 is required for providers/payers to support adjacent ONC/CMS regulation

Remove Must Support from PreAuthRef

Coverage Profile - modify .subscriber Reference resource

Define RelatedPerson Profile

AEOB Item links to GFE

On the AEOB profile, remove requirement for net; add requirement for adjudication

Make type of bill on institutional supportinginfo cardinality 1..1

which x12 specifications?

Institutional GFE - Chg procedure:primary to procedure:principal, modify definition

Add relatedPerson to Subscriber reference types

Updating / Cancelling AEOB Request

Change careTeam:rendering slice on Institutional GFE to only be a Human (not Organization)

Utilize Distinct FHIR Profiles for Professional and Institutional Claims

Add Disclaimer extension to GFEs

Make a stronger case as to why FHIR is the best

compoundDrugLinkingNum needs more guidance

PCT GFE Professional - Create identifier slices rather than extensions

Create slices on identifier instead of creating extensions

Require type and subtype in AEOB

PCT GFE Institutional - Identifiers. Add slices to .identifier rather than creating extensions

Institutional Profile - define Point of Origin, Admission Type and Discharge Status

Add the extension gfeProviderAssignedIdentifier to the AEOB Profile. (at the header level)

PCT Practitioner - remove endpoint extension add slice on contact

Plan or Coverage Entity Name and GFE Plan or Coverage Payer Name appear to be the same

Institutional profile - define careTeamSequence

Network status in advanced EOB profile

Professional profile - update careTeam

Institutional profile - add diagnosis slice, add invariants

More clearly define the purpose and constraints of ProviderEventMethodology

Provide means to declare an in or out of network/coverage status for AEOB

Provide a means to specify a denial reason in AEOB

PCT GFE Institutional - Claim.CareTeam:operating - PCT Practitioner, fix NUCC

Make Conformance statement verbs in bold format

Add provider descriptions for patients to both encounter and claim level

Add clarifying comment to processNote with best practice for patient information

Allow GFE Submitter to be Practitioner in Institutional GFE

Institutional and Professional profiles - NDC mapping and Value Set

Remove disclaimer extension from AEOB and update processNote description and cardinality

Harmonize Profiles with the CARIN BB IG

Harmonize CARIN BB and PCT FHIR data element mapping and Value Sets

Include a CapabilityStatement

Patient should be able to search EOBs, not get Bundles

polling mechanism in question

need to better explain the need for all the workflow steps

AEOB Query should take a different approach

Rewrite to make easier to understand the API

Change who gets authentication done in AEOB request from payer

Response to gfe-submit is unclear

Process Flow Revisions

Process for Sharing Advanced EOBs with Providers

Is return type form GFE Submit Appropriate?

Use of the FHIR API for Advanced AOBs to Member Must Be Optional

Diagram in Overview seems to imply that the Patient could only get a response from an Intermediary

Remove MS from AEOB.priority

Make AEOB.insurance.coverage MS

Professional profile - modify requirement for careTeam.qualification

Institutional profile - modify requirement for careTeam.qualification

Add note in overview that this IG does not address eligibility, prior authorization, or coordination of benefits

provider web portal?

GFE profiles need to require item.net

Use Claim.billablePeriod instead of creating a new extension

simplify menu navigation

Redesign subjectToMedicalMgmt extension to support CodeableConcept and string

Simplify or Replace figures with tables

Modify GFE and AEOB Bundle Graphics

Add service description to AEOB header

Need example of return from gfe-submit

GFE and AEOB Bundle Graphics

Add clarity for the operation outcome when server doesn't include AEOB

GFE and AEOB Bundle Graphics

Add a slice on AEOB.identifier for unique claim id to align with CARIN, but clarify in the description that it is the payer's claim id.

Detailed Requirements Summary

Specify OperationOutcome requirements for common outcomes

Make date of service required and add search parameter

Add Operational requirement that the GFE linked in the AEOB is an exact copy of the provider submitted GFE Bundle

Add an Operational requirement about GFE stored as is as originally received and not updated.

Define assumptions about what payers must verify in the GFE

Guiding principle for repeating items in GFE in AEOB

Specify more details on the scope of the IG regarding coordination of benefits and other use cases

Add slice requirements for AEOB adjudication categories

Consider GFE Value to Indicate if Member Has Agreed to Balance Billing

Add entry slices on Bundles for expected and required resource types

Add Relationshiop Diagram