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  1. FHIR Specification Feedback
  2. FHIR-46180

Consider the X12 270/271 process as a source of Member Attribution

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive
    • Icon: Medium Medium
    • US Da Vinci PDex (FHIR)
    • current
    • Financial Mgmt
    • PDex Provider Group
    • 6.2.3
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      The CMS Prior Authorization Rule leaves the construction of Attribution Lists to the discretion of the Payer.

      The IG does not attempt to require Payers to construct or maintain Attribution lists in a specific way use with the Provider Access API.

      It is therefore up to each individual Payer to determine whether they want to use inputs such as an X12 transaction to generate attribution lists. 

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      The CMS Prior Authorization Rule leaves the construction of Attribution Lists to the discretion of the Payer. The IG does not attempt to require Payers to construct or maintain Attribution lists in a specific way use with the Provider Access API. It is therefore up to each individual Payer to determine whether they want to use inputs such as an X12 transaction to generate attribution lists. 

      Many providers have an RCM system that is not fully integrated with their EHR/EMR. When an appointment is booked (no CRD Hook), they do a 270/271 eligibility request to verify a relationship with the patient. If the patient is found (as returned in the 271), this member should be attributed to the provider and added to the Member Attribution Group.

        1. Member Attribution Process - RCMs.pptx
          2.10 MB

            Unassigned Unassigned
            lmichaelsen Linda Michaelsen
            Genevieve Morris, Linda Michaelsen
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              Created:
              Updated:
              Resolved: