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  1. FHIR Specification Feedback
  2. FHIR-36182

It is not clear how relevant supporting information is sent to performing parties

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci CRD (FHIR)
    • 1.1.0-ballot [deprecated]
    • Financial Mgmt
    • Use Cases and Overview
    • 2.2.1
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      This IG doesn't deal with the order fulfillment process, which is what this would tie into.  There are a variety of options - Task, messaging, faxing, printing it on a piece of paper, etc.  CRD only deals with the process of getting the prior authorization information.  How the order and associated information gets to the performer is out of scope.

      We will add some information to DTR in the resolution to this ticket: FHIR-36253

      Will provide a specific link to the post-acute orders IG as a mechanism for conveying information from ordering to performing provider.

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      This IG doesn't deal with the order fulfillment process, which is what this would tie into.  There are a variety of options - Task, messaging, faxing, printing it on a piece of paper, etc.  CRD only deals with the process of getting the prior authorization information.  How the order and associated information gets to the performer is out of scope. We will add some information to DTR in the resolution to this ticket: FHIR-36253 Will provide a specific link to the post-acute orders IG as a mechanism for conveying information from ordering to performing provider.
    • Bob Dieterle / Rachael Foerster : 8-0-0
    • Clarification
    • Compatible, substantive
    • Yes

    Description

      In the "use-cases" overview, 2.2.1 Scenario 1, IG says

      Dr. Good completes the necessary paperwork to initiate a prior authorization and sends the relevant supporting information to the imaging center as part of the referral.

      However, it is not clear from the IG how this supporting information about prior auth is sent to the imaging center as part of the referral. As I understand, this is necessary for the imaging center to submit a claim for reimbursement.

      So I request that the IG detail the technical specifications / methodologies for how the prior authorization related information available on the ordering side is transferred to the performing side for purposes of claim submission.

      Especially considering the IG deliberately moves the authorization workflow from the performing side to the ordering side, I feel strongly that this is a major gap in the IG which will cause financial burden for performing organizations unless appropriately addressed.

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            Unassigned Unassigned
            m_varghese Varghese Mathew
            Varghese Mathew
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            Dates

              Created:
              Updated:
              Resolved: