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  1. FHIR Specification Feedback
  2. FHIR-41014

add guidance value for "we need performing details to respond"

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci CRD (FHIR)
    • 1.0.0 [deprecated]
    • Financial Mgmt
    • Coverage Guidance Value Set [deprecated]
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      We will add three new values to Coverage Guidance valueset/code system:

      1) Perform:  If performing provider, location, or date is required (can deal with this at order dispatch or order set revision)

      2) PerformerPA:  PA required, but only performing provider may request PA (may still need DTR to gather ordering provider information, but cannot submit PAS)

      3) DetailedCode:  If high level code and detailed code is required to determine coverage / PA (same regarding DTR) – may combine with (2)?

      Provide guidance in the IG for the use of these values, in particular regarding Perform and the situations which may exist around performing provider and date. 

      Lloyd will provide additional description of possible scenarios.

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      We will add three new values to Coverage Guidance valueset/code system: 1) Perform :  If performing provider, location, or date is required (can deal with this at order dispatch or order set revision) 2) PerformerPA :  PA required, but only performing provider may request PA (may still need DTR to gather ordering provider information, but cannot submit PAS) 3) DetailedCode :  If high level code and detailed code is required to determine coverage / PA (same regarding DTR) – may combine with (2)? Provide guidance in the IG for the use of these values, in particular regarding Perform and the situations which may exist around performing provider and date.  Lloyd will provide additional description of possible scenarios.
    • Bob Dieterle / Mark Scrimshire : 4-0-1
    • Enhancement
    • Non-compatible
    • Yes

    Description

      When discussing expectations about payers needing to provide a real response to CRD, we've identified a common scenario of "I can't respond with real guidance until I have the performing details- I need the service date, performing provider, providing location", with the expectation that that information will be determined by the EHR later and available in a subsequent hook (be it order-dispatch, order-set-revision, appointment-book).

      However this is not yet a discrete value in the coverage guidance value set. We should update https://build.fhir.org/ig/HL7/davinci-crd/ValueSet-coverageGuidance.html to add an appropriate value ("performing-details-needed"?)

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            Unassigned Unassigned
            kjohnsen Kyle Johnsen
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              Created:
              Updated:
              Resolved: