Difference between revisions of "201809 Coverage Requirements Discovery"
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Revision as of 15:45, 26 June 2018
Coverage Requirements Discovery (CRD)
Submitting WG/Project/Implementer Group
The Da Vinci Project
The goal of the CRD Implementation Guide is to allow healthcare payers to be able to query payers to determine:
- Specific documentation requirements
- Rules for determining need for specific treatments/services
- Requirement for Prior Authorization (PA) or other approvals
- Specific guidance
This track will be testing the ability of a participants to issue a FHIR Operation to discover coverage requirements. It is expected that there will be a reference implementation of the FHIR Operation in a FHIR server to mimic the response with coverage requirement documentation. The track will test the CRD IG that is being balloted in September. This test will help demonstrate:
- Profiles of FHIR resources along with the operation allow the necessary information for discovery of coverage discovery
- Profiles of FHIR resources allow the communication of the location of coverage requirement documentation back to providers.
Proposed Track Lead
Andy Gregorowicz - The MITRE Corporation - firstname.lastname@example.org
Cerner, Epic, Allscripts, CMS (via The MITRE Corporation), United, Humana, Anthem
Please include information here regarding how much advance preparation will be required if creating a client and/or server.
Role 1 Name
Scenario Step 1 Name
- Success Criteria:
- Bonus point: