Having trouble mapping X12 elements to Claim.item.detail and Claim.item.subdetail

atofuk · January 27, 2021, 11:07pm

Hi!

I’m currently mapping X12 837 elements to the Claim FHIR resource, and I was wondering if the Financial FHIR resources were designed with the X12 837/835s in mind?

If so, I was wondering if you could provide some guidance on what kinds of X12 837 elements might map to Claim.item.detail, Claim.item.subdetail? I’ve looked through the entire X12 837 specification guide and didn’t find suitable elements to map to these, but these are pretty large child elements so if the FHIR resources were designed with X12 837 formats in mind, I’m obviously missing something pretty big.

And, if you know what kinds of claims formats were used in designing FHIR resources (if there were any) and can share, that would be great!

Note: I saw this related post so I understand that the actual mappings are proprietary.

lloyd · January 28, 2021, 3:15am

They were designed with an intention to support Claims processes in a wide variety of countries. They generally don’t have elements that are limited in utility to only one or two countries - the general expectation is that those are handled via extensions. If you are interested in mappings to X12, you might reach out to X12 for the 278 mappings (provided you’re a member). Those might inform mappings to other X12 specifications. We haven’t created formal mappings for formal claims submissions because, so far, there hasn’t been a strong enough (i.e. funded) initiative to do that work.

pknapp · February 2, 2021, 6:41pm

X12 Claims support expressing billable items at both the header (patient) and service (line item level). FHIR expresses billable items only at the Claim.item level. FHIR also provides a 3-tier structure (.items which can contain .details which can contain .subdetails) so that complex billable things can be more appropriately represented. When mapping X12 service elements into FHIR Claim.item elements each service line in X12 is represented as one .tem - with .item.productOrService being the billing code (CPT/NCPDP/CDT etc), the revenue code in the .item.revenue etc.