Details
-
Change Request
-
Resolution: Persuasive with Modification
-
Medium
-
US Da Vinci CDex (FHIR)
-
2.0.0
-
Payer/Provider Information Exchange
-
CDex Task Attachment Request Profile
-
Using CDex Attachments with DaVinci PAS
-
-
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:
- Rewrite Using CDex Attachments with DaVinci PAS page
- Remove the existing flow diagrams
- rewrite the page referencing the updated PAS content in , Request for Additional Information
- 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
Attachments
Issue Links
- relates to
-
FHIR-44867 Clarify CDex interactions in Figure 3.1 - Request For Additional Information Workflow
- Triaged