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  1. FHIR Specification Feedback
  2. FHIR-35071

Professional profile - modify .insurance.preAuthRef

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive
    • Icon: Medium Medium
    • US Da Vinci Patient Cost Transparency (PCT) (FHIR)
    • 0.1.0 [deprecated]
    • Financial Mgmt
    • STU
    • (NA)
    • 7.7.1
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      The current IG supports inclusion of the PreAuth number at the claim level (not line level) and that is sufficient for a first iteration of the PCT IG.  Prior Authorization is a separate process from Cost Estimates and so this information may or may not be available at this time in the workflow for a provider to share with a payer at the time of GFE Submit. 

      Should the community see a need for more information for pre-auth numbers at the line level, we can explore that addition in a future IG with a new ticket. 

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      The current IG supports inclusion of the PreAuth number at the claim level (not line level) and that is sufficient for a first iteration of the PCT IG.  Prior Authorization is a separate process from Cost Estimates and so this information may or may not be available at this time in the workflow for a provider to share with a payer at the time of GFE Submit.  Should the community see a need for more information for pre-auth numbers at the line level, we can explore that addition in a future IG with a new ticket. 
    • Corey Spears / Vanessa Candelora : 20-0-1

    Description

      The professional claim allows one prior authorization number at the claim level and one at the line level for the destination payer. The line level can hold up to 4 other prior authorization numbers for non-destination payers.  Modify the professional profile, .insurance.preAuthRef to align with claims submission standards.  

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            taylorpatriciab Patricia Taylor
            Patricia Taylor
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              Updated:
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