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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Highest Highest
    • US Da Vinci CRD (FHIR)
    • 1.1.0-ballot [deprecated]
    • Financial Mgmt
    • STU
    • CRD IG Home Page
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      Change "Providers who fail to adhere to payer or coverage expectations may find that costs for a given service are not covered or are only partially covered"

      to

      "Claims submitted for payment that do not meet payer coverage or documentation requirements will typically be initially denied and may result in delays due to resubmission or appeals and/or financial impact to the patient."

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      Change "Providers who fail to adhere to payer or coverage expectations may find that costs for a given service are not covered or are only partially covered" to "Claims submitted for payment that do not meet payer coverage or documentation requirements will typically be initially denied and may result in delays due to resubmission or appeals and/or financial impact to the patient."
    • Bob Dieterle / Chris Cioffi : 12-0-0
    • Clarification
    • Non-substantive

    Description

      This framing is not fair. Physicians have asked payers to provide their PA criteria only to be told it's proprietary. Yet it's "providers who fail to adhere to payer or coverage expectations"? From our findings "Failure of payers to disclose transparent prior authorization requirements has resulted in 34% of physicians reporting that PA has led to a serious adverse event for a patient in their care." Suggest revising.

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            Unassigned Unassigned
            celine_lefebvre Celine Lefebvre
            Celine Lefebvre
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              Created:
              Updated:
              Resolved: