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  1. FHIR Specification Feedback
  2. FHIR-43097

Question appropriateness of Create or update coverage information in CRD IG

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci CRD (FHIR)
    • Financial Mgmt
    • Cards Profiles
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      Member match is focused on ensuring the 'identity' of the member is correct, but doesn't actually share any coverage information at all.

      We will update the specification to say the following:

      "If returning a card rather than a system action, this card type SHOULD NOT be returned for hook types that are likely to be triggered by clinical users rather than administrative staff.  I.e. Cards of this type would be appropriate for hooks such as encounter-start or appointment-book, but would not be appropriate for order-select or order-sign."

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      Member match is focused on ensuring the 'identity' of the member is correct, but doesn't actually share any coverage information at all. We will update the specification to say the following: "If returning a card rather than a system action, this card type SHOULD NOT be returned for hook types that are likely to be triggered by clinical users rather than administrative staff.  I.e. Cards of this type would be appropriate for hooks such as encounter-start or appointment-book, but would not be appropriate for order-select or order-sign."
    • Clarification
    • Non-substantive

      https://hl7.org/fhir/us/davinci-crd/cards.html#create-or-update-coverage-information

      This workflow appears to overlap with with HRex member-match. Do we really want to provide similar functionality? This doesn’t seem like the appropriate place to do this. Additionally ordering clinicians are not likely to update coverage information at the time they are ordering a service. This would be outside the workflow they are intending to accomplish and likely would not have the correct information to intervene appropriately. 

      If there is a mismatch between payer and provider, that should be resolved in a separate workflow. There should be some error handling to deal with a situation where information is not synchronized.

            rosemaryh Rosemary Hofstede
            fpandolfe Frank Pandolfe
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              Created:
              Updated:
              Resolved: