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  1. FHIR Specification Feedback
  2. FHIR-44870

Clarify that PAS is a special case where the PROVIDER create the Task

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    • Icon: Change Request Change Request
    • Resolution: Persuasive with Modification
    • Icon: Medium Medium
    • US Da Vinci CDex (FHIR)
    • 2.0.0
    • Payer/Provider Information Exchange
    • CDex Task Attachment Request Profile
    • Using CDex Attachments with DaVinci PAS
    • Hide
      1. Remove the Using CDex Attachments with DaVinci PAS page.
      2. Add Section referencing PAS' Request for Additional Information for Prior Authorization
      3. highlight the differences between the PAS and CDex for this use case
        1. The Provider (vs the PAYER in CDEX) shall create the Task defined in the PAS IG which is required to launch the DTR app,
        2.  The questionnaire's endpoint is communicated as an identifier in the PAS IG questionnaire r vs a canonical uri in CDex.
        3. In CDex we assume the Payer supplies the Task in PAS the shares business identifiers via X12 or other means.  However,  In PAS, because the payer creates the Task FHIR IDs are exchanged. 
      4. Define when PAS guidance (and PAS Task) is used.
        1. When implementing Da Vinci Burden reduction workflow for prior authorization and in situations where the prior authorization request is ‘pended' and additional information is requested from the provider with a X12 278 Response
        2. and When a payer requests a questionnaire and the provider's DTR functionality is a third-party SMART on FHIR App
        3. and It may be used if the Provider implements CDEX in a separate module.  The Task is used to represent the information that is needed to make the CDex transaction ( $submit-attachment, Launch DTR)
        4. otherwise the CDex guidance is used for submitting attachments.
      Show
      Remove the  Using CDex Attachments with DaVinci PAS page . Add Section referencing PAS' Request for Additional Information for Prior Authorization highlight the differences between the PAS and CDex for this use case The Provider (vs the PAYER in CDEX) shall create the Task defined in the PAS IG which is required to launch the DTR app,  The questionnaire's endpoint is communicated as an identifier in the PAS IG questionnaire r vs a canonical uri in CDex. In CDex we assume the Payer supplies the Task in PAS the shares business identifiers via X12 or other means.  However,  In PAS, because the payer creates the Task FHIR IDs are exchanged.  Define when PAS guidance (and PAS Task) is used. When implementing Da Vinci Burden reduction workflow for prior authorization and in situations where the prior authorization request is ‘pended' and additional information is requested from the provider with a X12 278 Response and When a payer requests a questionnaire and the provider's DTR functionality is a third-party SMART on FHIR App and It may be used if the Provider implements CDEX in a separate module.  The Task is used to represent the information that is needed to make the CDex transaction ( $submit-attachment, Launch DTR) otherwise the CDex guidance is used for submitting attachments.
    • Clarification
    • Compatible, substantive

    Description

      In Da Vinci Prior Authorization Support (PAS) FHIR IG, "a payer may request additional information from the provider to support a prior authorization request by responding to the X12 278 Request with an X12 278 Response.  In this case the Provider receives a PAS Response Bundle, and not a Payer supplied Task. 

      This transactions corresponds to the following CDex Scenarios:

      1) If the Payer is requesting documents. --> Payer requests additional documentation to support a claim or prior authorization using an X12 transaction, fax, portal, or other capabilities. The Provider can submit these solicited attachments can use the $submit-attachment operation to “push” the attachments directly to the Payer.

      2) If the Payer is requesting a Questionnaire be filled out :

          a) If the provider's DTR functionality is embedded in the Provider's system then the Provider can submit the solicited attachments/questionnaireresponse using using the $submit-attachment operation to “push” the attachments directly to the Payer.

        b) SPECIAL CASE NOT DOCUMENTED IN CDEX If the provider's DTR functionality is a third-party SMART on FHIR App , then the Provider (vs the PAYER in CDEX) shall create the Task defined in the PAS IG  to launch the DTR app, and use the $submit-attachment operation to “push” the attachments directly to the Payer.  The sequence diagram in CDEX's  Requesting Attachments Using Questionnaires is the same.  The questionnaire's endpoint is communicated as an identifier in the PAS IG questionnaire r vs a canonical uri in CDex.

      One big difference between them is In CDex we assume the Payer shares business identifiers via X12 or other means.  However,  In PAS, because the payer creates the Task FHIR IDs are exchanged.  
       
       

      Propose:

      1. Rewrite Using CDex Attachments with DaVinci PAS page
        1. Remove the existing flow diagrams
        2. rewrite the page referencing  the updated PAS content in , Request for Additional Information
      2. Add Boilerplate Alerts to the reader about the PAS special case and reference the Using CDex Attachments with DaVinci PAS page
        • Solicited and Unsolicited Attachments
        • Requesting Attachments Using Questionnaires
        • Conforming to CDex Attachments

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            Unassigned Unassigned
            ehaas Eric Haas
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              Created:
              Updated:
              Resolved: