Stream: Da Vinci
Topic: CRD examples
Lloyd McKenzie (Aug 12 2018 at 16:41):
Does anyone have any realistic examples of coverage requirements they'd like to share? I'd welcome any, but specific things I'm looking for include:
- proposal for a couple of alternative prescriptions that would be covered when the prescribed med is not (would need drugs, doses, etc. for both current and proposed alternates)
- a 'short' form a practitioner would need to submit as part of pre-auth or claim submission
- a situation where an order for a therapy would mean pre-requisite/co-occurring orders would also be needed (for lab tests, confurrent meds, etc.)
Isaac Vetter (Aug 13 2018 at 17:31):
Lloyd, it seems like another realistic example is just the simple case of returning documentation. I'd suggest that a reference implementation should definitely include the easiest "hello world" use-case and would also benefit from being realistic.
Lloyd McKenzie (Aug 13 2018 at 19:51):
I tried to include a semi-realistic example for that one. Feel free to propose something better :)
Viet Nguyen (Aug 13 2018 at 22:54):
This is a public site of a payer that lists a large number of data submission forms that are thematically (not specifically) related to what CRD is doing - https://www.anthem.com/wps/portal/ahpmedprovider?content_path=provider/in/f4/s0/t0/pw_b131791.htm&rootLevel=3&label=Commercial%20Medical%20-Surgical%20Clinical%20Data%20Submission%20Tools
This is a relatively short form from CMS for CPAP - https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms10269.pdf
Lloyd McKenzie (Aug 13 2018 at 22:55):
I'd love even shorter... :)
Viet Nguyen (Aug 13 2018 at 22:57):
The top and bottom 1/3 of this form is generalizable for all imaging studies -https://www.optimahealth.com/documents/forms/prior-authorization/form-doc-ctcta-authorization-form.pdf
Last updated: Apr 12 2022 at 19:14 UTC
