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  1. FHIR Specification Feedback
  2. FHIR-36997

Alignment with other ePA guides

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci CDex (FHIR)
    • 1.1.0-ballot [deprecated]
    • Patient Care
    • STU
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      (draft resolution): 

      how CDEx conveys that the request is for purposes of an existing prior-auth or claim (one or more),

       Will add section to Attachments page that documents the CDEX Attachments and New Request Attachments Transactions workflows and how they intersect with the Da Vinci PAS (Burden Reduction) IG.

      Here is a preview: https://hackmd.io/FgHFic4VTGqJaomMW2fJiQ?view

       

      why the technique used to identify the additional data and submission is different (e.g., use of Questionnaire/QuestionnaireResponse in DTR and submission using Claim).

      CDEX attachments is proposed as a "FHIR based alternative the X12 277, 278 and 275 transactions as a potential requirements of the Attachments Rule which is scheduled to be introduced by CMS Division of National Standards this fiscal year.  Further, the HIPAA requires that the standard needs to be compatible with existing X12 Transactions ( see attached image). The CDEX specification is defined to be fully compatible - the DTR Q/QR is not.  (e.g., There is no way to specify anything other than a LOINC code in the 277, 278response )

      There is no direct intersection with DTR/CRD workflow (http://hl7.org/fhir/us/davinci-dtr/index.html). In DTR, the Q/QR is held until any  required Tasks(http://hl7.org/fhir/us/davinci-dtr/specification__behaviors__task_creation.html) are completed and the question is answered which not compatible with the CDex attachments workflow. CDEX is proposing to use Task to identify the additional data and $submit-data operation to submit data.   

      Will add to attachments introduction that these transaction are designed to be defined to be compatible with the  X12n 277, 278 and 275 transactions.

      Show
      (draft resolution):  how CDEx conveys that the request is for purposes of an existing prior-auth or claim (one or more),  Will add section to Attachments page that documents the CDEX Attachments and New Request Attachments Transactions workflows and how they intersect with the Da Vinci PAS (Burden Reduction) IG. Here is a preview: https://hackmd.io/FgHFic4VTGqJaomMW2fJiQ?view   why the technique used to identify the additional data and submission is different (e.g., use of Questionnaire/QuestionnaireResponse in DTR and submission using Claim). CDEX attachments is proposed as a "FHIR based alternative the X12 277, 278 and 275 transactions as a potential requirements of the Attachments Rule which is scheduled to be introduced by CMS Division of National Standards this fiscal year.  Further, the HIPAA requires that the standard needs to be compatible with existing X12 Transactions ( see attached image). The CDEX specification is defined to be fully compatible - the DTR Q/QR is not.  (e.g., There is no way to specify anything other than a LOINC code in the 277, 278response ) There is no direct intersection with DTR/CRD workflow ( http://hl7.org/fhir/us/davinci-dtr/index.html ). In DTR, the Q/QR is held until any  required Tasks( http://hl7.org/fhir/us/davinci-dtr/specification__behaviors__task_creation.html ) are completed and the question is answered which not compatible with the CDex attachments workflow. CDEX is proposing to use Task to identify the additional data and $submit-data operation to submit data.    Will add to attachments introduction that these transaction are designed to be defined to be compatible with the  X12n 277, 278 and 275 transactions.
    • Eric Haas/Bob Dieterle: 8-0-3
    • Enhancement
    • Compatible, substantive

    Description

      It is unclear from this guide, and the DTR and PAS guide how CDex is used.  It would be helpful in either of the guides, if not all, to describe the flow when additional data is necessary how CDEx conveys that the request is for purposes of an existing prior-auth or claim (one or more), and why the technique used to identify the additional data and submission is different (e.g., use of Questionnaire/QuestionnaireResponse in DTR and submission using Claim).

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            Unassigned Unassigned
            hbuitendijk Hans Buitendijk
            Celine Lefebvre, Hans Buitendijk
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            Dates

              Created:
              Updated:
              Resolved: