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  1. FHIR Specification Feedback
  2. FHIR-41381

Add narrative stating that the Prior Authorization profile also applies to the Payer to Payer use case

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US Da Vinci PDex (FHIR)
    • current
    • Financial Mgmt
    • PDex Prior Authorization
    • Home
      PDex Prior Authorization
    • Hide

      In index.html

      The STU2 version of the IG incorporates changes to support the sharing of Prior Authorization information with members, providers and other payers. This is done through the profiling of the [ExplanationOfBenefit](PDexPriorAuthorization.html) resource.

      In Prior Authorization pre-amble:

      The PDex Prior Authorization profile has been created to enable Payers to communicate prior authorization decisions and changes to the status of a prior authorization to members, providers and other payers.

       

       

      Show
      In index.html The STU2 version of the IG incorporates changes to support the sharing of Prior Authorization information with members, providers and other payers. This is done through the profiling of the [ExplanationOfBenefit] (PDexPriorAuthorization.html) resource. In Prior Authorization pre-amble: The PDex Prior Authorization profile has been created to enable Payers to communicate prior authorization decisions and changes to the status of a prior authorization to members, providers and other payers.    
    • Mark Scrimshire / Rachael Foerster : 10-0-2
    • Clarification
    • Compatible, substantive
    • Yes
    • 2.0.0-ballot

    Description

      In the 0057 proposed rule it includes prior authorization requests and decisions, not only in the Patient Access API and Provider Access API, but the Payer-to-Payer Data Exchange: https://www.cms.gov/newsroom/fact-sheets/advancing-interoperability-and-improving-prior-authorization-processes-proposed-rule-cms-0057-p-fact

      Add narrative stating that the Prior Authorization profile also applies to the Payer to Payer use case both in the index.md (Home) page and the Prior auth pages (input\pagecontent\StructureDefinition-pdex-priorauthorization-intro.md, input\pagecontent\PDexPriorAuthorization.md)

       

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            Unassigned Unassigned
            corey_spears Corey Spears
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              Updated:
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