Implementers of one IG aren't required to implement the other 2 IGs, and even if they implement all three, they might not roll them out simultaneously or provide support for all types of orders/events across all 3 IGs simultaneously.  The guides therefore need to provide guidance about how they will function in a stand-alone fashion. Change the following: Information gathered by DTR might be used for direct submission of prior authorizations to support X12 278 transactions or using alternative submission means (e.g. fax, mail) if supported/required by the relevant payer by adding The goal of the Burden Reduction IGs is to move from Telephone, FAX, Portal, mail) to electronic transaction defined by these three IGs.  We recognize it will take time for provider and payer to fully implement these IGs and that certain PAs may never be implemented due to complexity.  However, the intent is to move a rapidly as possible to full support of these IGs by Payer, providers and any required intermediaries. Also see  FHIR-36463