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  1. FHIR Specification Feedback
  2. FHIR-38742

prior-auth card type too broad for config

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci CRD (FHIR)
    • 1.1.0-ballot [deprecated]
    • Clinical Decision Support
    • CRD Card Types Value Set
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      Will replace "prior-auth" with:
      "auth-req" - "Is prior authorization required for the current service or not, or is there additional data that needs to be collected to make that determination?"

      "unsolicited-determ" - "The payer might provide an unsolicited approval of the service as covered (similar to, but not quite the same as a 'prior authorization)"

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      Will replace "prior-auth" with: "auth-req" - "Is prior authorization required for the current service or not, or is there additional data that needs to be collected to make that determination?" "unsolicited-determ" - "The payer might provide an unsolicited approval of the service as covered (similar to, but not quite the same as a 'prior authorization)"
    • Bob Dieterle / Rachael Foerster : 8-0-0
    • Correction
    • Non-compatible
    • Yes

    Description

      Following discussion of https://jira.hl7.org/browse/FHIR-36134, the question of "is our current config granular enough" came up. Skimming the card types http://hl7.org/fhir/us/davinci-crd/2022May/ValueSet-cardType.html I see a potential issue

      prior-auth Prior Authorization Is prior authorization required or not (and possibly provision of unsolicited prior authorizations)

      Is very broad- I think we're likely to run into a scenario where a client wants to know if prior auth is required or not, but isn't ready for unsolicted auths (maybe they haven't implemented a way to write the ClaimResponse yet).

      We should split up this card type- maybe spin off a new "unsolicited-auth" or "unsolicted-determination" type.

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            Unassigned Unassigned
            kjohnsen Kyle Johnsen
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              Created:
              Updated:
              Resolved: