Talk:FICO Domain Issues

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Rene: I'm not sure what you mean by this statement: "Note: Acts that need to be invoiced are associated with 0..1 Account (A_Account) acts as per the other financial domains."

(Kathleen)Acts that need to be invoiced are associated with financial transaction(s) that may be posted against several accounts - e.g., the patient billing account as a credit and the guarantor's bank account as a debit. There are other accounts that may be involved as well such as cost accounts and other general ledger accounts. This is my understanding, and there may be modeling reasons for the way you described the association.
I've changed the sentence to singular: 1 act - 0..* accounts Rene spronk 01:26, 23 Feb 2006 (CST)

RE Lloyd's use case: "(Lloyd) One use-case that's not addressed by the current A_coverage CMET is to indicate coverage in "request" mood as well as "event". I.e. When I send a prescription, I may need to indicate that the prescriber has submitted a coverage extension for the drug, but does not yet have an answer" This use case seems to be a kind of prior authorization and may include assurances of being paid for the service. FICR has a prior authorization messages, so maybe we need a CMET that is derived from that RMIM indicating that prior authorization is in process.

I'm afraid this is out of my area of expertise. Rene spronk 01:26, 23 Feb 2006 (CST)

There is a related use case that A_Coverage and even R_CoveredParty CMETs could be used in the RQO mood to support - it's an eligibilty verification at the service level (as opposed to the higher level of coverage in general under a policy or program) - as in

  • (for R_CoveredParty) "Patient is a covered party under Policy X who is participating/the subject of a clinical act for which the provider has requested information about whether the clinical act is a covered service under the policy."
  • (for A_Coverage) For a prescription: "Prescriber has submitted an eligibility verification request to find out if this drug is covered under the policy/is in formulary/has co-pay, but does not yet have an answer"

Release 2 A_Coverage and R_CoveredParty will support that functionality.

The use-case that one would have to communicate this sounds rather far fetched, but if this is a real use-case then it obviously should be covered. Rene spronk 01:26, 23 Feb 2006 (CST)

I've wanted to add RQO to the Act.Mood codes to Coverage within the FICO DMIM but there's no act.mood x_domain that supports only EVN,DEF,RQO - Could I use x_ActMoodDocumentObservation? There may be a use case for INT/PRP/PRMs