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  1. FHIR Specification Feedback
  2. FHIR-36528

it is essential that payers create extensive CQL for payer rule automation

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Highest Highest
    • US Da Vinci DTR (FHIR)
    • 1.1.0-ballot [deprecated]
    • Clinical Decision Support
    • STU
    • Formal Specification
    • 4.4
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      Reword:

      One of the core purposes of this specification is to automate the processing of payer rules in a manner that reduces provider burden. Authors of payer rules should keep this in mind as they create CQL. 

        to 

      One of the core purposes of this specification is to automate the retrieval of documentation required by the payer in a manner that reduces provider burden. Authors of DTR questionnaires SHOULD include CQL to auto-populate the questionnaire as much as possible. 

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      Reword: One of the core purposes of this specification is to automate the processing of payer rules in a manner that reduces provider burden. Authors of payer rules should keep this in mind as they create CQL.    to  One of the core purposes of this specification is to automate the retrieval of documentation required by the payer in a manner that reduces provider burden. Authors of DTR questionnaires SHOULD include CQL to auto-populate the questionnaire as much as possible. 
    • Bob Dieterle / Isaac Vetter : 11-0-0
    • Clarification
    • Compatible, substantive

    Description

      While DTR may be used for other purposes, in the case of the PA use case, it is essential that payers create extensive CQL for payer rule automation, without that there will be undue burden on providers and delays in care for patients. Furthermore, it may also discourage provider adoption if clinicians need to input a lot of values.

      See sentence "One of the core purposes of this specification is to automate the processing of payer rules in a manner that reduces provider burden. Authors of payer rules should keep this in mind as they create CQL"

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            celine_lefebvre Celine Lefebvre
            Celine Lefebvre
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              Updated:
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