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  1. FHIR Specification Feedback
  2. FHIR-44153

clarify subscriptions are required in use cases - monitor for resolution

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US Da Vinci PAS (FHIR)
    • 2.0.1
    • Financial Mgmt
    • Use Cases and Overview
    • 2.4.6
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      Update the last paragraph to be the following:

      "In those situations where the prior authorization request is ‘pended’, the EHR must monitor for changes to the request until the results are finalized. This monitoring might be done by the system of the provider that submitted the request for prior authorization, and/or the system of the provider that is expected to actually perform the authorized procedure (e.g. the family physician system or the imaging center system).

      A PAS Subscription has been created to allow systems to monitor for specific requests.  In response to a subscription notification indicating that the prior authorization has been changed, there is an inquiry operation that allows for returning information about prior authorization submissions.  This operation can also be used for generic inquiries about a prior submission."

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      Update the last paragraph to be the following: "In those situations where the prior authorization request is ‘pended’, the EHR must monitor for changes to the request until the results are finalized. This monitoring might be done by the system of the provider that submitted the request for prior authorization, and/or the system of the provider that is expected to actually perform the authorized procedure (e.g. the family physician system or the imaging center system). A PAS Subscription has been created to allow systems to monitor for specific requests.  In response to a subscription notification indicating that the prior authorization has been changed, there is an inquiry operation that allows for returning information about prior authorization submissions.  This operation can also be used for generic inquiries about a prior submission."
    • Bob Dieterle / Jeff Brown : 12-0-1
    • Clarification
    • Non-substantive

      During connectathon there was confusion over the language in the first paragraph of  https://build.fhir.org/ig/HL7/davinci-pas/usecases.html#monitor-for-resolution 

      "In those situations where the prior authorization request is ‘pended’, the EHR must monitor for changes to the request until the results are finalized. This monitoring might be done by the system of the provider that submitted the request for prior authorization, and/or the system of the provider that is expected to actually perform the authorized procedure (e.g. the family physician system or the imaging center system). This will be done by querying the payer system/intermediary. This might be done in response to a subscription notification indicating that the prior authorization has been changed. There is also an inquiry operation that allows for inquiries about prior authorization submissions. This inquiry can be used for checking the status of a request and for generic inquiries."

      People were reading that and coming away confused about when subscriptions were actually required or not (on the formal specification page, it gets more into how subscriptions are used for the provider organization that requests the auth, and that the inquiry operation can be used in response to a subscription notification or be used more broadly by organizations other than the requester). We should restructure the paragraph to make this more clear.

            Unassigned Unassigned
            kjohnsen Kyle Johnsen
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              Created:
              Updated:
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