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  1. FHIR Specification Feedback
  2. FHIR-36570

need to urge payers to leverage all 3 guides to make PAS worthwhile for providers to implement

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Highest Highest
    • US Da Vinci PAS (FHIR)
    • 1.2.0-ballot [deprecated]
    • Financial Mgmt
    • STU
    • Use Cases and Overview
    • 2.3.3
    • Hide

      Replace this sentence:

      "In the absence of CRD support by EHR or payer, other mechanisms such as consulting the payer's website and/or emailing or faxing the payer must be used."

      with this:

      "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."

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      Replace this sentence: "In the absence of CRD support by EHR or payer, other mechanisms such as consulting the payer's website and/or emailing or faxing the payer must be used." with this: "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."
    • Bob Dieterle / Rachael Foerster : 10-0-1
    • Clarification
    • Non-substantive

    Description

      See sentence: "In the absence of CRD support by EHR or payer, other mechanisms such as consulting the payer's website and/or emailing or faxing the payer must be used."

      The provider should not have to resort to manual methods to determine whether prior authorization is required. Without full implementation of all three guides (CRD, DTR, PAS), ROI will be low for providers if they have to exit EMR workflow for other steps. If payers don't support CRD/DTR, providers will not be motivated to use PAS – not enough value.

      Across all three guides there are many references to solutions that are either antiquated or proprietary, which is not the point of having a standard. More consideration and expectation needs to be given to the implementation of all the guides in concert.

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