Da Vinci Payer Coverage Decision FHIR IG Proposal
Contents
- 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
PutProposedIGNameHere
Owning work group name
Financial Management
Committee Approval Date:
Approved by FM on 7/2/2019
Publishing Lead
Paul Knapp pknapp@pknapp.com
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. The plan is to use the CarePlan resource as the basis for associating the information with regard to current therapy.
Content location
https://github.com/HL7/davinci-pcovex
Proposed IG realm and code
US/DaVinci-PCD
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
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
Involved parties
This implementation guide has been developed by U.S. Payer organizations as part of the Da Vinci project.
Expected implementations
Da Vinci payer members in response to the details in the CMS final rule
Content sources
Example Scenarios
IG Relationships
Timelines
When IG Proposal Is Complete
When you have completed your proposal, please send an email to FMGcontact@HL7.org