Stream: implementers
Topic: Payor Pre-Authorization
Bo Pritchard (Jul 25 2018 at 20:15):
I'm looking but can not find any reference to a Payor Pre-Authorization.
I would expect it to be at the Account.Coverage.payor level
This when Aetna, for example, would say "we authorize payment for three visits for Patient X, etc "
Any help?
Thanks
Lloyd McKenzie (Jul 25 2018 at 20:16):
Claim covers actual claims as well as pre-authorizations and pre-determinations
Paul Knapp (Jul 25 2018 at 20:18):
@Bo Pritchard Not at the account level as a patient may have multiple coverages the benefits of which would accrue to the account.
A pre-authorization is a use on the Claim Resource which represents a claim, preauthorization or a predetermination. Please see the Claim and ClaimResponse as well as examples and join the Financial Management WG calls, Tuesday at 11 Eastern for discussions.
Bo Pritchard (Jul 25 2018 at 20:23):
Ok, I think I understand now. I was thinking of Claim as only a request for reimbursement.
Lloyd McKenzie (Jul 25 2018 at 20:25):
The name is a little misleading. However, we've had trouble coming up with a better name that would be better understood. Suggestions welcome :)
Last updated: Apr 12 2022 at 19:14 UTC
