Da Vinci Payer Coverage Decision FHIR IG Proposal

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.

When IG Proposal Is Complete

When you have completed your proposal, please send an email to FMGcontact@HL7.org