Mapping IIB 15C form with expalnation of benefits resource (EoB) #65
ajitsingh2801
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As discussed in the Domain working group call today, noting down some more areas/questions (specially people from Insurance side) that need help in understanding:
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Based on our discussions with internal and external stakeholder, we have found following info to the aformentioned questions -
@abhimail comment -
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An enhancement is proposed to HCX specifications to enable information reporting and fetching in previous discussion post - #60. One of the key use cases of information reporting is : payors need to send report about the claims processed by them to IIB. IIB has defined a format, form 15C, to send this information to them.
In the discussion post #60, the FHIR resource explanation of benefits (EOB) is proposed to be used as the payload for information reporting. We did an attempt of mapping the EOB resource fields to the Form 15C fields. The mapping is available in this sheet (https://docs.google.com/spreadsheets/d/1pjSEfEhILods1MJdTEla60ac-ClLUbez/edit#gid=123965058). Request the community to review and share feedback & comments on the proposed field mapping.
Listed below are the questions for which we need help from the community. Please share your inputs on following open questions :
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