Template:FHIR IG Proposal

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IMPORTANT: DO NOT COPY & PASTE FROM YOUR PSS: The purpose of the elements in the IG Proposal is different. The IG Proposal should not talk about the "project" at all.

The displayed contents below this line is the outline for a resource proposal

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For additional guidance on considerations for IG creation, refer to FHIR IG Considerations

Payer Coverage Decision Exchange

Owning work group name

Financial Management

Committee Approval Date:

Please enter the date that the committee approved this IGproposal

Publishing Lead

Paul Knapp

Contributing or Reviewing Work Groups

Attachments

FHIR Development Project Insight ID

1515

Scope of coverage

This IG will provide a FHIR standard for exchanging, at member request, current treatments/support, conditions, guidelines (commercial), and supporting documentation for a payer member with a new payer when the member moves from one covered payer to another. This is to support the "treatment portability" described in the CMS Interoperability NPRM from March 3, 2019.

Scope should consider numerous aspects of breadth of scope, including:

• Subject: Human vs. non-human vs. non-patient (e.g. lab bench medicine)
• Disciplines: Environmental Health, Palliative, Respiratory, Psychology, Maternity, Clinical Research
• Delivery environment (Community, Geriatric, Home care, Emergency, Inpatient, Intensive, Neonatal, Pediatric, Primary)
• Locale: Country, region

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Content location

https://github.com/HL7/davinci-pcd

Proposed IG realm and code

US

Maintenance Plan

Da Vinci project intends to provide ongoing support of this implementation guide.

Short Description

Payer coverage decision exchange will promote continuity of treatment when a member moves from one covered payer to another without increasing provider burden or cost to the member. Member-authorized sharing of treatment, conditions, authorizations, relevant guidelines and supporting documentation.

Long Description

1(-2) paragraphs describing the purpose/scope of the IG in more detail for inclusion in the version history - this is content that will be used in your IG's equivalent of this: http://www.hl7.org/fhir/us/core/history.cfml. Again, this must describe the IG from the perspective of an implementer scanning a registry, it should not talk about the project and should NOT be copied from the PSS.

Involved parties

1 paragraph describing who is sponsoring or involved in creating the IG for inclusion in the version history. Don't copy from the PSS - think about the specific language you want to appear in the registry.

Expected implementations

Provide named implementations if possible - ideally provide multiple independent implementations

Content sources

List all of the specifications (beyond those in the standard list of source specifications) that you’re planning to consult

Are there any source specifications that you wish to consult but are concerned about access to or expertise to consider?

Example Scenarios

Provide a listing of the types of scenarios to be represented in the examples produced for this IG. They should demonstrate the full scope of the IG and allow exercising of the IG's capabilities (all profiles, different types of applications, etc.)

IG Relationships

Are there any IGs this resource depends on or that depend on this IG?

Timelines

Indicate the target date for having the IGcomplete from a committee perspective and ready for vetting and voting

When IG Proposal Is Complete

When you have completed your proposal, please send an email to FMGcontact@HL7.org