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  1. FHIR Specification Feedback
  2. FHIR-36576

Missing Medical Necessity Review Requests and Experimental and Investigational Treatment Requests

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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
    • Supported Hooks
      Technical Background
      Use Cases and Overview
    • Hide

      Will update the use-case section to include an example where the "what if" function allows the clinician to put in some minimum information to see if the benefit is covered at all (and no prior auth involved).

      Becky will try to provide a realistic scenario.

      Show
      Will update the use-case section to include an example where the "what if" function allows the clinician to put in some minimum information to see if the benefit is covered at all (and no prior auth involved). Becky will try to provide a realistic scenario.
    • Bob Dieterle / Chris Cioffi : 12-0-0
    • Clarification
    • Non-substantive

    Description

      The IG should include workflows for Medical Necessity Review Requests and Experimental and Investigational Treatment Requests. As an example, medical necessity review requests for medical nutrition therapy (MNT) happen in instances where MNT is covered for some diagnosis(es) but may not include or specify a patient's diagnosis, or it is unclear whether the MNT will be covered, e.g. GI conditions, malnutrition, patient with NALFD and OSA - or cancers, etc.

      In Person resolution requested.

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            Unassigned Unassigned
            bgradl Becky Gradl
            Becky Gradl
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              Created:
              Updated:
              Resolved: