Stream: Da Vinci
Topic: CRD/DTR and PAS
Sreekanth Puram (Jan 11 2020 at 14:27):
The implementation guide talks about how an EHR would use the CDS hooks to pass on order information to the payer and how to invoke a smart on fhir app to gather information from ehr and send it to the payer. However I don’t see anything in the IG on how to transmit the status of the PA, a confirmation number in case of affirmation, or a denial reason in case of denial back to the EHR. Am I missing something?
Sreekanth Puram (Jan 13 2020 at 23:42):
The implementation guide talks about how an EHR would use the CDS hooks to pass on order information to the payer and how to invoke a smart on fhir app to gather information from ehr and send it to the payer. However I don’t see anything in the IG on how to transmit the status of the PA, a confirmation number in case of affirmation, or a denial reason in case of denial back to the EHR. Am I missing something?
Any Opinions?
Benjamin Langley (Jan 27 2020 at 13:16):
Sreekanth I believe the ClaimResponse.outcome shows the status of whether or not the Claim has been processed. As for details on granted/denied the Review Action Code and Review Action Reason transmit those details (https://build.fhir.org/ig/HL7/davinci-pas/artifacts.html#extensions)
Vanessa Candelora (Jan 15 2021 at 15:24):
Hi there, You may have seen that CMS dropped a “CMS Interoperability and Prior Authorization” final rule this morning: https://www.cms.gov/newsroom/press-releases/cms-puts-patients-over-paperwork-new-rule-addresses-prior-authorization-process We have CMS joining for a Q&A session in about 40 min, find it in the Whova Agenda titled: “CMS Patient Access
API Final Rule and Burden Reduction NPRM Q&A” at 8am PT (11AM ET) if you want to attend. Alex Mugge and Lorraine Doo from CMS will be on, with Viet hosting. Please join us!
Last updated: Apr 12 2022 at 19:14 UTC
