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  1. FHIR Specification Feedback
  2. FHIR-40512

Allow both person (practitioner) as well as Organization (non-person) in Claim.provider

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US Da Vinci PAS (FHIR)
    • current
    • Financial Mgmt
    • PAS Claim Update
    • Artifacts Summary
    • 9.9.1.1
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      The PAS Guide intentionally only allowed the requesting provider to be an Organization.

      We did not consider the case where a provider might query for an authorization and the response would have the requestor to be a Person.  We will need to adjust the inquiry response to support that and if we do that, we might as well adjust all the profiles.

      We will adjust the Claim, Claim Inquiry, Claim Response, and Claim Inquiry Response to support individual Practitioners sending in an authorization request.

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      The PAS Guide intentionally only allowed the requesting provider to be an Organization. We did not consider the case where a provider might query for an authorization and the response would have the requestor to be a Person.  We will need to adjust the inquiry response to support that and if we do that, we might as well adjust all the profiles. We will adjust the Claim, Claim Inquiry, Claim Response, and Claim Inquiry Response to support individual Practitioners sending in an authorization request.
    • Bob Dieterle / Rachael Foerster : 10-0-1
    • Correction
    • Compatible, substantive

    Description

      This IG is intended to map to the X12 278 X217 to allow for a HIPAA compliant transaction creation. Within the 278 X217 2010B NM1 Requestor Name, NM102 allows for both a Person - Code Value = '1' or a Non-Person - Code Value = '2'. This accommodates a request from either a individual practitioner or a provider organization. However, the PAS IG allows only an Organization and does not accommodate a request from a Practitioner.  X12 mapping to FHIR shows a hard mapping of NM102 to qualifier '2' - "Non-Person Entity" and NM103 Name Last or Organization Name to FHIR mapping: Organization.name

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            mike_denison Mike Denison
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