201809 Coverage Requirements Discovery

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Track Name

Coverage Requirements Discovery (CRD)

Submitting WG/Project/Implementer Group

The Da Vinci Project

Justification

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 - andrewg@mitre.org

See Connectathon_Track_Lead_Responsibilities

Expected participants

Cerner, Epic, Allscripts, CMS (via The MITRE Corporation), United, Humana, Anthem

Roles

Please include information here regarding how much advance preparation will be required if creating a client and/or server.

Role 1 Name

Scenarios

Scenario Step 1 Name

Action:
Precondition:
Success Criteria:
Bonus point:


TestScript(s)

Security and Privacy Considerations