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This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.
The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows
The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.
Use Case: A health plan member has a physical insurance card, which contains demographic and plan information for coverage and cost sharing. This IG would develop a digital rendering of the physical insurance card mapped via FHIR. Applications could then display a rendering of the physical card via an app, which could be used as an alternative to the physical insurance card as proof of insurance.
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This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.
The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows
The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.
Use Case: A health plan member has a physical insurance card, which contains demographic and plan information for coverage and cost sharing. This IG would develop a digital rendering of the physical insurance card mapped via FHIR. Applications could then display a rendering of the physical card via an app, which could be used as an alternative to the physical insurance card as proof of insurance.