Difference between revisions of "Product CR"
(New page: ==Product Brief - == back to Main_Page<br/>back to Product_List ===Product Name=== ===Topics=== * ===Standard Category=== * ===Integration Paradigm=== * ===Type=== ===Releases=...) |
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| Line 1: | Line 1: | ||
| − | ==Product Brief - == | + | ==Product Brief - HL7 V3: Claims & Reimbursements== |
back to [[Main_Page]]<br/>back to [[Product_List]] | back to [[Main_Page]]<br/>back to [[Product_List]] | ||
===Product Name=== | ===Product Name=== | ||
| + | HL7 V3: Claims & Reimbursements | ||
| + | ===Topics=== | ||
| + | *Authorization | ||
| + | *Coverage Extension | ||
| + | *Eligibility | ||
| + | *Invoice | ||
| + | *Payment Advice | ||
| + | *Pre-Determination | ||
| + | *Pre-Determination-Authorization | ||
| + | *Poll | ||
| + | *Special Authorization | ||
| + | *SOFA (Statement of Financial Activity) | ||
| − | |||
| − | |||
===Standard Category=== | ===Standard Category=== | ||
| − | * | + | *Health Information Exchange Standards |
===Integration Paradigm=== | ===Integration Paradigm=== | ||
| − | * | + | *Messaging |
===Type=== | ===Type=== | ||
| + | Normative, ANSI standard | ||
| + | ===Releases=== | ||
| + | *ANSI/HL7 V3 CR: R1-2004, R2-2004, R3-2005, R4-2008; | ||
| + | *DSTU: HL7 V3 CR SA, R4 - Special Authorization R1 | ||
| − | === | + | ===Summary=== |
| + | The Claims and Reimbursement (CR) Domain is one of several areas within Healthcare Services for which HL7 is defining messaging standards. CR pertains to the invoicing (including authorization and eligibility verification), adjudication and payment (including adjustments and account queries) of Healthcare Services. | ||
| + | The CR domain is one of two financial domains that make up the Financial (FI) sub-section within the Administrative Management (AM) section. FIAB is the domain for patient accounting (charges, etc.) whereas FICR deals with requests for payments (claims, invoices). | ||
| − | + | All of the interactions within the CR Domain assume the participants know the detailed information about Providers, Insurance Companies and Patients. That is, there is a shared repository of information that exists between the receiver and sender and therefore, details on these elements are not expected in messages. | |
| + | This document provides support for Generic, Pharmacy, Preferred Accommodation, Physician, Oral Health Vision Care and Hospital claims for eligibility, authorization, coverage extension, pre-determination, invoice adjudication, payment advice and Statement of Financial Activity (SOFA) Release 3 of this document adds claims messaging support for Physician, Oral Health Vision Care and Hospital claims. | ||
===Description=== | ===Description=== | ||
| − | + | These interactions include Query Eligibility, Authorization, Coverage Extension, Pre-Determination, Invoice (claim), Adjudication Results, Payment Advice and Statement of Financial Activity (SOFA). | |
===Business Case (Intended Use, Customers)=== | ===Business Case (Intended Use, Customers)=== | ||
| − | + | *Provider: Healthcare Institutions (hospitals, long term care, home care, mental health) | |
| + | *Vendor: Health Care IT | ||
| + | *Payers | ||
| + | *Local and State Departments of Health | ||
===Benefits=== | ===Benefits=== | ||
| Line 33: | Line 53: | ||
====Work Groups==== | ====Work Groups==== | ||
| − | http://www.hl7.org/Special/committees/ | + | [http://www.hl7.org/Special/committees/fm/index.cfm Financial Management] |
====Education==== | ====Education==== | ||
| − | + | * See more at http://www.hl7.org/implement/training.cfm | |
| − | * See more at http:// | ||
=====Certification Available===== | =====Certification Available===== | ||
*none | *none | ||
| Line 45: | Line 64: | ||
* | * | ||
===Links to current projects in development=== | ===Links to current projects in development=== | ||
| − | + | none | |
Revision as of 19:30, 21 October 2009
Contents
- 1 Product Brief - HL7 V3: Claims & Reimbursements
- 1.1 Product Name
- 1.2 Topics
- 1.3 Standard Category
- 1.4 Integration Paradigm
- 1.5 Type
- 1.6 Releases
- 1.7 Summary
- 1.8 Description
- 1.9 Business Case (Intended Use, Customers)
- 1.10 Benefits
- 1.11 Implementations/ Case Studies (Actual Users)
- 1.12 Resources
- 1.13 Relationship to/ Dependencies on, other standards
- 1.14 Links to current projects in development
Product Brief - HL7 V3: Claims & Reimbursements
back to Main_Page
back to Product_List
Product Name
HL7 V3: Claims & Reimbursements
Topics
- Authorization
- Coverage Extension
- Eligibility
- Invoice
- Payment Advice
- Pre-Determination
- Pre-Determination-Authorization
- Poll
- Special Authorization
- SOFA (Statement of Financial Activity)
Standard Category
- Health Information Exchange Standards
Integration Paradigm
- Messaging
Type
Normative, ANSI standard
Releases
- ANSI/HL7 V3 CR: R1-2004, R2-2004, R3-2005, R4-2008;
- DSTU: HL7 V3 CR SA, R4 - Special Authorization R1
Summary
The Claims and Reimbursement (CR) Domain is one of several areas within Healthcare Services for which HL7 is defining messaging standards. CR pertains to the invoicing (including authorization and eligibility verification), adjudication and payment (including adjustments and account queries) of Healthcare Services.
The CR domain is one of two financial domains that make up the Financial (FI) sub-section within the Administrative Management (AM) section. FIAB is the domain for patient accounting (charges, etc.) whereas FICR deals with requests for payments (claims, invoices).
All of the interactions within the CR Domain assume the participants know the detailed information about Providers, Insurance Companies and Patients. That is, there is a shared repository of information that exists between the receiver and sender and therefore, details on these elements are not expected in messages.
This document provides support for Generic, Pharmacy, Preferred Accommodation, Physician, Oral Health Vision Care and Hospital claims for eligibility, authorization, coverage extension, pre-determination, invoice adjudication, payment advice and Statement of Financial Activity (SOFA) Release 3 of this document adds claims messaging support for Physician, Oral Health Vision Care and Hospital claims.
Description
These interactions include Query Eligibility, Authorization, Coverage Extension, Pre-Determination, Invoice (claim), Adjudication Results, Payment Advice and Statement of Financial Activity (SOFA).
Business Case (Intended Use, Customers)
- Provider: Healthcare Institutions (hospitals, long term care, home care, mental health)
- Vendor: Health Care IT
- Payers
- Local and State Departments of Health
Benefits
Implementations/ Case Studies (Actual Users)
Resources
Work Groups
Education
- See more at http://www.hl7.org/implement/training.cfm
Certification Available
- none
Presentations
Relationship to/ Dependencies on, other standards
Links to current projects in development
none
