Uploaded image for project: 'FHIR Specification Feedback'
  1. FHIR Specification Feedback
  2. FHIR-40414

Need a way to query on a Prior Authorization when the 278 conversion is not required

    XMLWordPrintableJSON

Details

    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US Da Vinci PAS (FHIR)
    • current
    • Financial Mgmt
    • Formal Specification
    • 5.2.6
    • Hide

      We will add to section 5.2.3 the following around the inquiry and response process:

      Providers are expected to perform the same query-by-example inquiry even under the CMS exception.  This Implementation Guide does not specify a different way of searching for prior authorizations in the exception case.

      Show
      We will add to section 5.2.3 the following around the inquiry and response process: Providers are expected to perform the same query-by-example inquiry even under the CMS exception.  This Implementation Guide does not specify a different way of searching for prior authorizations in the exception case.
    • Bob Dieterle / Jeff Brown : 9-0-1
    • Clarification
    • Non-substantive

    Description

      With the Da Vinci exception process, there will be some payers that submit the FHIR PAS Request Bundle directly to the Payer. What query (potentially with _include or _revinclude) would need to be run to make an inquiry on the response to serve the same function as the Claim Inquiry Operation and/or does it need to be an operation?

      Request is to define what a provider doing straight FHIR for Prior Auth would need to do to inquire on a prior auth status

      Attachments

        Activity

          People

            Unassigned Unassigned
            lmichaelsen Linda Michaelsen
            Watchers:
            2 Start watching this issue

            Dates

              Created:
              Updated:
              Resolved: