Details
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Change Request
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Resolution: Persuasive with Modification
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Medium
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US Da Vinci CRD (FHIR)
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1.1.0-ballot [deprecated]
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Financial Mgmt
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Supported Hooks
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Bob Dieterle / Jeff Brown : 22-0-1
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Clarification
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Non-substantive
Description
May payers do service type based delegation extensively.
So for example, I am a payer,
- all my radiology prior authorization and utilization management is delegated to this business entity X
- All physical therapy and occupational therapy services performed by "Large clinical network" is delegated to "large clinical network" and they self manage
- All other physical therapy and occupational therapy prior authorization and utilization management is delegated to business entity Y
- All other procedures are done in house by the payer themselves.
This is a common business model, and not something that can be changed just for the sake of a CRD specification.
To add another orthogonal complexity layer, medication prior authorization will likely never use CRD, but will use NCPDP interfaces.
So based on all this, it is not possible for the EHR client to determine the CRD endpoint merely from the coverage being used. Nor is it possible for the EHR client to know all of these payer rules and use service + coverage to determine what CRD endpoint to use either.
Likewise, in section 4.4.1 Registering DTR apps with CRD, it is a SHALL requirement that the DTR Launch URL is the same for all DTR cards returned by a given CRD service. This is not practical or reasonable either.
CRD needs to support, and specify how CRD (and perhaps DTR) discovery happens in all of these partially delegated arrangements that are extremely common in the real world!
Attachments
Issue Links
- is voted on by
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BALLOT-32415 Negative - Christopher Schaut : 2022-May-FHIR IG COVREQDISC R2 STU
- Withdrawn
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BALLOT-33526 Negative - Daniel Rutz : 2022-May-FHIR IG COVREQDISC R2 STU
- Withdrawn
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BALLOT-33548 Negative - Thanos Tsiolis : 2022-May-FHIR IG COVREQDISC R2 STU
- Withdrawn
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BALLOT-33570 Negative - Chris Courville : 2022-May-FHIR IG COVREQDISC R2 STU
- Withdrawn
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BALLOT-33614 Negative - Daniel Zhang : 2022-May-FHIR IG COVREQDISC R2 STU
- Withdrawn
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BALLOT-33658 Negative - David Sundaram-Stukel : 2022-May-FHIR IG COVREQDISC R2 STU
- Withdrawn
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BALLOT-33680 Negative - Isaac Vetter : 2022-May-FHIR IG COVREQDISC R2 STU
- Withdrawn
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BALLOT-33702 Negative - Amit Popat : 2022-May-FHIR IG COVREQDISC R2 STU
- Withdrawn
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BALLOT-33724 Negative - Cooper Thompson : 2022-May-FHIR IG COVREQDISC R2 STU
- Withdrawn
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BALLOT-33746 Negative - Danielle Friend : 2022-May-FHIR IG COVREQDISC R2 STU
- Withdrawn
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BALLOT-33592 Negative - Peter DeVault : 2022-May-FHIR IG COVREQDISC R2 STU
- Balloted
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BALLOT-33636 Negative - Michael Clifton : 2022-May-FHIR IG COVREQDISC R2 STU
- Balloted
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BALLOT-33768 Negative - Vassil Peytchev : 2022-May-FHIR IG COVREQDISC R2 STU
- Balloted
- relates to
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FHIR-36183 It is not clear how the EHR knows the CRD endpoint from the coverage
- Published
- mentioned in
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