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  1. FHIR Specification Feedback
  2. FHIR-29257

Payer-to-Payer ingestion guidance

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    Details

    • Type: Change Request
    • Status: Resolved - change required (View Workflow)
    • Priority: Medium
    • Resolution: Persuasive
    • Specification:
      US Da Vinci PDex (FHIR)
    • Raised in Version:
      0.1
    • Work Group:
      Financial Mgmt
    • Related Page(s):
      (many)
    • Related Section(s):
      4.2
    • Grouping:
    • Resolution Description:
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      Update the PDex IG  to provide guidance (but not requirements) on options a payer can take to CONSUME the data from the prior plan. 

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      Update the PDex IG  to provide guidance (but not requirements) on options a payer can take to CONSUME the data from the prior plan. 
    • Resolution Vote:
      Mark Scrimshire / Pat Taylor : 17-0-5
    • Change Category:
      Clarification
    • Change Impact:
      Non-substantive
    • Pre Applied:
      Yes

      Description

      The CMS Rule requires the implementation of Payer-to-Payer exchange in 2022. PDex includes reference to a $member-match operation that enables a new payer to check with a member/prospective member's prior payer(s). If a unique member is matched the new payer will be able to request the health record from the prior health plan.

      The PDex IG will be updated to provide some guidance (but not requirements) on options a payer can take to CONSUME the data from the prior plan. 

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            Assignee:
            Unassigned Unassigned
            Reporter:
            ekivemark Mark Scrimshire
            Watchers:
            2 Start watching this issue

              Dates

              Created:
              Updated:
              Resolved:
              Vote Date: