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Da Vinci Payer Coverage Decision FHIR IG Proposal

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Owning work group name

Financial Management

Committee Approval Date:

Approved by FM on 7/2/2019

Publishing Lead

Paul Knapp

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.

Content location

Proposed IG realm and code


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

Involved parties

Expected implementations

Content sources

Example Scenarios

IG Relationships


When IG Proposal Is Complete

When you have completed your proposal, please send an email to

FMG Notes