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  1. FHIR Specification Feedback
  2. FHIR-34101

Need a ClaimResponse profile for prior auth

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Details

    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US Da Vinci HRex (FHIR)
    • current
    • Clinical Interoperability Council
    • (NA)
    • Bob Dieterle / Jay Lyle : 13-0-0
    • Enhancement
    • Compatible, substantive
    • Yes

    Description

      Both CRD and DTR have a need to be able to create an "unsolicited" prior authorization that captures the details of what's been authorized, including:

      • the billing code(s) authorized
      • dollar amounts authorized
      • modifiers authorized
      • quantities authorized
      • authorization number to quote

      The profile should be aligned with the PAS ClaimResponse but should be much simpler, only mandating the key elements that a provider's admin staff would need to know in order to subsequently submit a successful claim.

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            Unassigned Unassigned
            lloyd Lloyd McKenzie
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            Dates

              Created:
              Updated:
              Resolved: