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Interoperability Proving Ground (IPG) submissions within the ONC Tech Lab are submitted by healthcare, technology and development organizations that are invested in Health IT and Interoperability and want to share, learn and collaborate with similar stakeholders in the US, and around the world.
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Da Vinci Payer Coverage Decision Exchange
Description
This FHIR based Implementation Guide was developed by the Da Vinci Project in coordination with the HL7 Financial Management Workgroup. This guide defines the exchange of specific coverage/treatment decisions from one payer to another payer to allow for continued coverage of specific treatments without needing to repeat the review and authorization process. The decisions may be based on commercial guidelines that can be uniquely referenced or based on specific payer rules (if and when available and defined in a structured, rules-based manner, without a proprietary payer's evaluation process). This guides supports the exchange of the supporting documentation used to validate the necessity for coverage of specific treatments This work builds on the Payer Data Exchange (PDex) Implementation Guide to define patient driven/authorized exchange methods to meet the anticipated requirements for coverage portability.
Start Date
05/17/2019
Projected End Date
Project Point of Contact:
davincipmoremove@removelists.hl7.org
Project Results
None