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Template:FHIR IG Proposal

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To use this Template:

  1. Search (or Go to) for a page with name like xxxxx_FHIR_IG_Proposal
  2. Click on the RED link to the (previously) undefined page in order to edit it.
  3. Type {{subst::Template:FHIR IG Proposal}} as the only content for the new page.
  4. Preview (if desired) to verify the reference was typed correctly
  5. "Save" the page.
    At this point, the contents of this template (with the following exceptions) will replace the substitution link. The exceptions are:
    • These instructions will not appear.
    • The small blue-font annotations about each entry will be replaced with an <!-- XML Comment --> saying the same thing. These comments are visible while editing, but they do not appear when the Wiki page is previewed or saved.
  6. Re-edit the page to include the appropriate content in each of the sections
  7. Save again

IMPORTANT: DO NOT COPY & PASTE FROM YOUR PSS: The purpose of the elements in the IG Proposal is different. The IG Proposal should not talk about the "project" at all.

The displayed contents below this line is the outline for a resource proposal


For additional guidance on considerations for IG creation, refer to FHIR IG Considerations


Payer Coverage Decision Exchange

Owning work group name

Financial Management

Committee Approval Date:

Please enter the date that the committee approved this IGproposal

Publishing Lead

Paul Knapp

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.

Scope should consider numerous aspects of breadth of scope, including:

  • Subject: Human vs. non-human vs. non-patient (e.g. lab bench medicine)
  • Disciplines: Environmental Health, Palliative, Respiratory, Psychology, Maternity, Clinical Research
  • Delivery environment (Community, Geriatric, Home care, Emergency, Inpatient, Intensive, Neonatal, Pediatric, Primary)
  • Locale: Country, region
-->

Content location

https://github.com/HL7/davinci-pcd

Proposed IG realm and code

US

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

1(-2) paragraphs describing the purpose/scope of the IG in more detail for inclusion in the version history - this is content that will be used in your IG's equivalent of this: http://www.hl7.org/fhir/us/core/history.cfml. Again, this must describe the IG from the perspective of an implementer scanning a registry, it should not talk about the project and should NOT be copied from the PSS.


Involved parties

This implementation guide has been developed by U.S. Payer organizations as part of the Da Vinci project.

Expected implementations

Provide named implementations if possible - ideally provide multiple independent implementations

Content sources

List all of the specifications (beyond those in the standard list of source specifications) that you’re planning to consult

Are there any source specifications that you wish to consult but are concerned about access to or expertise to consider?

Example Scenarios

Provide a listing of the types of scenarios to be represented in the examples produced for this IG. They should demonstrate the full scope of the IG and allow exercising of the IG's capabilities (all profiles, different types of applications, etc.)

IG Relationships

This project will reference, where possible the "standards" defined by the Health Record exchange (HRex) Framework Implementation Guide which in turn will utilize prior work from US Core and R4. In addition, this guide will refer to the Payer Data Exchange (PDex) Implementation Guide since it uses the same member directed exchange methods and clinical content standards for the Payer to Payer exchange described in PDex.

Timelines

Indicate the target date for having the IGcomplete from a committee perspective and ready for vetting and voting

When IG Proposal Is Complete

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

FMG Notes