Stream: Da Vinci PAS
Topic: Source of Resources Referenced in Request Bundle
Ben Lowit (Jun 11 2021 at 20:59):
Is there any particular expectation about which organization's FHIR server would be the source of the resources referenced by the Claim and included in the request Bundle? Would the attached resources always originate from the server of the provider making the request, or might they be hosted by the payer being interacted with?
In an ideal FHIR scenario, the provider would have first run matching operations on the payer to find the payer's version of references to the patient/providers/etc. so that during the main request, references to these entities would use the payer's own FHIR IDs to ensure matching isn't an issue. In this case, it wouldn't be necessary to include Bundle entries for the payer's own resources because that's sending their own data back to them. If the provider is instead sending all of their own resources, it means that the PAS interaction must attempt to perform matching and prior authorization processing at once, and a failure in either of these steps would cause an error that would require a full retry of this step by the provider. It seems useful for the provider to at least have the option to reference the payer's own resources to leave fewer matching checks that could fail during PAS, so I'd like to know if this is a possibility.
Jean Duteau (Jun 11 2021 at 21:16):
There actually is no expectation on the source of the various referenced resources. The Claim Bundles only mandate a Claim resource but do not require any other resources to be included. That would allow for the Claim references to be external to the Bundle and would satisfy your first case where the provider provides references to the payer's resources.
Last updated: Apr 12 2022 at 19:14 UTC
