Self-pay Encounters in R4

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Rob Rucker

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Apr 1, 2020, 2:35:57 PM4/1/20
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Hello FHIR folks,

The documentation for the Coverage resource that it can be used for "selfpay" (https://fhir.cerner.com/millennium/r4/financial/coverage/#overview) but the documentation for the Account resource also mentions self-pay (https://fhir.cerner.com/millennium/r4/financial/account/#account-types). Which way is recommended for app developers to check if an encounter is self-pay?

-Rob Rucker
--Moxe Health

Alex Beckner (Cerner)

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Apr 2, 2020, 10:58:28 AM4/2/20
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Hi Rob,

The guarantor-balance type of Account represents a self-pay balance. I believe you would want to search Coverage by the Encounter ID and use the payor field of the Coverage response to determine if the coverage is self-pay. The request provided below will return an example of a self-pay Coverage resource in the sandbox environment.



Thank you,
Alex (Cerner)

Rob Rucker

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Apr 2, 2020, 1:44:14 PM4/2/20
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When I navigate to that resource, I get a search set with three results: a Medicare Part A coverage, a Medicare Part B coverage, and a self-pay coverage. Does this mean that if there is any self-pay coverage on an encounter, the other coverages can safely be ignored? Is there a way to tell which one was actually used?

Also, across organizations that use Cerner, are the Coverage.payor.reference and the Coverage.payor.display values going to be consistent, or will they be different for each organization?

-Rob Rucker
--Moxe Health

Sean OQuinn (Cerner)

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Apr 2, 2020, 10:01:58 PM4/2/20
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Rob, 

The presence of SELF-PAY in a list of coverages for an encounter should not lead you to the conclusion that all other coverages should be ignored. The example you retrieved from FHIRPLAY may not be a great representation of the coverages you would find in a real scenario. 

Concerning the Coverage.payor reference display, those will vary across Cerner tenants/domains.

-Sean (Cerner)
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