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  1. FHIR Specification Feedback
  2. FHIR-23312

Payers must create Provenance records for Member records received through Member-mediated Information Exchange. - PDex #119

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci PDex (FHIR)
    • STU3
    • Financial Mgmt
    • (profiles) [deprecated]
    • 2-2-2
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      Add as paragraph 2 in section 2.2:
      "The Health Plan SHOULD create one or more Provenance Resources documenting where possible, the origin of the data, the method of exchange (e.g. V2, X12) and the identity of the health plan.

      The Provenance resource(s) if created SHALL be accessible via the query API to any valid downstream requestor of the resources using this IG."

      Note: We will develop a guidance paragraph addressing the issues to be considered, by both the sender and receiver, when a downstream recipient of data does not receive provenance information.

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      Add as paragraph 2 in section 2.2: "The Health Plan SHOULD create one or more Provenance Resources documenting where possible, the origin of the data, the method of exchange (e.g. V2, X12) and the identity of the health plan. The Provenance resource(s) if created SHALL be accessible via the query API to any valid downstream requestor of the resources using this IG." Note: We will develop a guidance paragraph addressing the issues to be considered, by both the sender and receiver, when a downstream recipient of data does not receive provenance information.
    • Bob Dieterle / Mark Scrimshire : 15-0-0
    • Enhancement
    • Compatible, substantive

    Description

      Existing Wording: 2-2-2 Member-mediated Information Exchange

      The CMS Notice For Proposed Rule Making for Patient access and Interoperability requires that a subscriber to a new health plan SHALL be able to request their information to be passed from their old health plan to their new health plan.

      A Member SHALL also be able to use APIs to share information with Third Party Applications. This includes:

      •Their health history

      •Healthcare network/directory information

      •Pharmacy network/directory information

      •Prescription Drug Formulary information

      Proposed Wording: 2-2-2 Member-mediated Information Exchange

      The CMS Notice For Proposed Rule Making for Patient access and Interoperability requires that a subscriber to a new health plan SHALL be able to request their information to be passed from their old health plan to their new health plan.

      The Health Plan SHALL create a Provenance Provenance Record documenting the source of the Member records, the identity of the health plan and the action taken to become the custodian of the data. The updated Provenance record SHALL be passed on to any downstream entity requesting the associated records.

      A Member SHALL also be able to use APIs to share information with Third Party Applications. This includes:

      •Their health history

      •Healthcare network/directory information

      •Pharmacy network/directory information

      •Prescription Drug Formulary information

      ADD@http://hl7.org/implement/standards/fhir/us/davinci-pdex/2019Jun/6-7_Handling_Data_Provenance.html

      6-7-1-2 Member information shared without Provenance

      The Health Plan SHALL create a Provenance Provenance Record documenting the source of the Member records, the identity of the health plan and the action taken to become the custodian of the data. The updated Provenance record SHALL be passed on to any downstream entity requesting the associated records.

      Comment:

      Payers must create Provenance records for Member records received through Member-mediated Information Exchange.

      Summary:

      Payers must create Provenance records for Member records received through Member-mediated Information Exchange.

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            Unassigned Unassigned
            k.connor Kathleen Connor
            Kathleen Connor
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              Updated:
              Resolved: