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  1. FHIR Specification Feedback
  2. FHIR-30446

Scenarios to include the Payer's ability to use CDex to request additional information from the Provider that will be used to support claim submission - Attachments.

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci CDex (FHIR)
    • current
    • Patient Care
    • Specification [deprecated]
    • Scenarios
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      Will update the language in the scenarios to include as a primary payor-provider use case:

      "Attachments to support claim submission , medical necessity and other reasons for attachments."

      Future plans include example scenarios to cover these use cases in supplemental guides.

      We will add some language to CDex indicating the circumstances when it might be used to solicit prior authorization and claims supporting information and when that should instead be handled via DTR/PAS.  We will also update PAS to note when CDex is an option for getting supporting information for prior authorization outside the PAS process.
       

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      Will update the language in the scenarios to include as a primary payor-provider use case: "Attachments to support claim submission , medical necessity and other reasons for attachments." Future plans include example scenarios to cover these use cases in supplemental guides. We will add some language to CDex indicating the circumstances when it might be used to solicit prior authorization and claims supporting information and when that should instead be handled via DTR/PAS.  We will also update PAS to note when CDex is an option for getting supporting information for prior authorization outside the PAS process.  
    • Eric Haas/Jay Lyle: 11-0-11
    • Clarification
    • Non-substantive

    Description

      Jira #FHIR 30446 -  Scenarios need language that will include the Payer's ability to use CDex to request additional information from the Provider that will be used to support claim submission - Attachments. Not just medical necessity, care management, and quality reporting.  Scope of the requests should be bound to the HIPAA Tab value set.  This will apple to both methods; Direct query and Task based.

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              Updated:
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