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  1. FHIR Specification Feedback
  2. FHIR-36192

Include CRD questionnaire workflow, not just prior auth questionnaire

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci DTR (FHIR)
    • 1.1.0-ballot [deprecated]
    • Clinical Decision Support
    • Use Cases and Overview
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      Add text:

      1. Call out that DTR can gather additional information to determine coverage of service or item. 
      2. Also, provide an example.

       

      See: FHIR-33960

      "One of the functions of DTR is absolutely to determine if prior authorization is required (or if a service is covered at all) if CRD can't make that determination itself by querying the EHR." 

       

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      Add text: Call out that DTR can gather additional information to determine coverage of service or item.  Also, provide an example.   See: FHIR-33960 "One of the functions of DTR is absolutely to determine if prior authorization is required (or if a service is covered at all) if CRD can't make that determination itself by querying the EHR."   
    • Bob Dieterle / Isaac Vetter : 11-0-0
    • Clarification
    • Non-substantive

    Description

      From the coverageGuidance value set, one can see that it is possible for the coverage determination itself to not be completed without further information, including potentially a DTR questionnaire:

      Code Display Definition
      not-covered Not covered no coverage or possibility of coverage for this service)
      covered Covered regular coverage applies
      prior-auth Prior authorization coverage is possible with prior authorization
      clinical Clinical clinical details are required to determine coverage/prior auth applicability - e.g. via DTR by clinician
      admin Admin administrative details are required to determine coverage/prior auth applicability - e.g. via DTR by clinician

      This is a separate use of DTR than prior auth. This variant of the DTR workflow needs to be called out in the DTR spec's Use Cases.

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            rgeimer Rick Geimer
            ramccormick Rachael McCormick (Inactive)
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              Updated:
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