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  1. FHIR Specification Feedback
  2. FHIR-26521

If the value in the process Note/text is "Not Covered", would a reject reason such as "Prior authorization denied…

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    Details

    • Type: Change Request
    • Status: Resolved - change required (View Workflow)
    • Priority: Medium
    • Resolution: Persuasive with Modification
    • Specification:
      US CARIN Real-time Pharmacy Benefit Check (RTPBC) (FHIR)
    • Work Group:
      Pharmacy
    • Related Artifact(s):
      RTPBC Response Profile (ClaimResponse)
    • Related Page(s):
      Profiles and Extensions
    • Grouping:
    • Resolution Description:
      Hide

      In the ClaimResponse profile's Must Support section...
      CHANGE:
      The error composite MUST be populated when the responder cannot complete processing due to a business rule or data exception. Otherwise, the item composite MUST be populated

      TO:
      Every response must contain either an item composite or an error composite, but not both. The Item composite MUST be populated when sufficient information is received to be able to answer the request.

      The error composite MUST be populated when the responder cannot complete processing due to insufficient or invalid information in the request. 

      Show
      In the ClaimResponse profile's Must Support section... CHANGE: The error composite MUST be populated when the responder cannot complete processing due to a business rule or data exception. Otherwise, the item composite MUST be populated TO: Every response must contain either an item composite or an error composite, but not both. The Item composite MUST be populated when sufficient information is received to be able to answer the request. The error composite MUST be populated when the responder cannot complete processing due to insufficient or invalid information in the request.  
    • Resolution Vote:
      Melva Peters / Pooja Babbrah : 13-0-1
    • Change Category:
      Clarification
    • Change Impact:
      Non-substantive
    • Applied for Version:
      0.1.0

      Description

      If the value in the process Note/text is "Not Covered", would a reject reason such as "Prior authorization denied. Provider not authorized to Rx this drug. Need a Prior Authorization from a different prescriber go into ...error/text?

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              Assignee:
              Unassigned Unassigned
              Reporter:
              Gonzaga Zabrina Gonzaga
              Watchers:
              1 Start watching this issue

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                Updated:
                Resolved:
                Vote Date: