| 1 |
Additional COB data in Response- Adjudication Details |
New fields to indicate how much of cost/markup/fee cutbacks can be passed on to secondary third parties and to patient. Includes a policy type (eg private/public). This data is passed on in downstream/secondary claims. Purpose is to help pharmacies obey terms insurer makes with clients. |
Adjudicator must include data |
POS must include in downstream FHIR claims
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| 14 |
Special Auth Days Supply in the Claim Response |
New field in the response to convey the authorized says supply |
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| 16 |
Special Auth Remaining Quantity |
New field in the Claim Response |
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| 13 |
Special Auth Period |
New field in the Claim Response to convey start and expiry dates of a special auth |
POS must sender when applicable |
Receivers will use the data as required |
