Difference between revisions of "Da Vinci Payer Coverage Decision FHIR IG Proposal"
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Revision as of 19:34, 2 July 2019
- 1 PutProposedIGNameHere
- 1.1 Owning work group name
- 1.2 Committee Approval Date:
- 1.3 Publishing Lead
- 1.4 Contributing or Reviewing Work Groups
- 1.5 FHIR Development Project Insight ID
- 1.6 Scope of coverage
- 1.7 Content location
- 1.8 Proposed IG realm and code
- 1.9 Maintenance Plan
- 1.10 Short Description
- 1.11 Long Description
- 1.12 Involved parties
- 1.13 Expected implementations
- 1.14 Content sources
- 1.15 Example Scenarios
- 1.16 IG Relationships
- 1.17 Timelines
- 1.18 When IG Proposal Is Complete
- 1.19 FMG Notes
Owning work group name
Committee Approval Date:
Approved by FM on 7/2/2019
Paul Knapp email@example.com
Contributing or Reviewing Work Groups
FHIR Development Project Insight ID
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. The plan is to use the CarePlan resource as the basis for associating the information with regard to current therapy.
Proposed IG realm and code
Da Vinci project intends to provide ongoing support of this implementation guide
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.
The Payer Coverage Decision (PCD) Exchange FHIR IG will support the secure Member-authorized exchange of information between a current and prior payer regarding ongoing problems/treatments 1) The exchange will use OAuth2.0 and FHIR APIs for information sharing 2) Information to exchange will include the "careplan" for any current conditions/treatments 3) Relevant conditions 4) Relevant guidelines (reference to commercially available guidelines) 5) Any relevant prior-authorizations, with any remaining scope/duration (e.g. number of authorized session left) 6) relevant past or current medical history used to support coverage of the current treatment 7) other information as appropriate
This implementation guide has been developed by U.S. Payer organizations as part of the Da Vinci project.
When IG Proposal Is Complete
When you have completed your proposal, please send an email to FMGcontact@HL7.org