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  1. FHIR Specification Feedback
  2. FHIR-36139

More clarity around how UM Payer multi party arangements are handled

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci DTR (FHIR)
    • 1.0.0 [deprecated]
    • Clinical Decision Support
    • Retrieval of Payer Resources [deprecated]
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      The payer can specify the endpoint to be a payer's, third party, Utilization Management Organization, or Business Association. Where ever the questionnaires, CQL, and value sets are made available. 

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      The payer can specify the endpoint to be a payer's, third party, Utilization Management Organization, or Business Association. Where ever the questionnaires, CQL, and value sets are made available. 
    • Bob Dieterle / Isaac Vetter : 11-0-0
    • Clarification
    • Non-substantive

    Description

      • Need more clarity around PAYER side definition. Some of our orgs are UM only and contract to provide UM services for the payers they work with. In this situation it is unclear who is providing the rules/CQL/Questionnaire. May need a situation where the DTR request is sent to the UM organization but the source of truth for DTR specifications is from a payer which is a separate entity

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            thorn Thomas Horn (Inactive)
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              Created:
              Updated:
              Resolved: