Details
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Change Request
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Resolution: Not Persuasive with Modification
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Highest
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US Da Vinci DTR (FHIR)
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1.1.0-ballot [deprecated]
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Clinical Decision Support
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CQL [deprecated]
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Bob Dieterle / Howard Strasberg: 13-0-2
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Clarification
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Non-substantive
Description
IG states "Authors of payer rules should keep this in mind as they create CQL. Due to differences in workflows or information systems, clinical information may be represented in different FHIR resources or with different codes or code systems. Therefore, payer CQL may have to examine different resources or use value sets to find patient information. It is preferable to have more extensive CQL or value sets than require a user to input values that the rules were unable to find."
This language seems insufficient. There needs to be a requirement that payers map their CQLs to the prior authorization criteria for specific services.
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