The process/transaction would not be needed if the provider knows WHEN document is needed. - CDex #25

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    • Type: Change Request
    • Resolution: Persuasive with Modification
    • Priority: Medium
    • US Da Vinci CDex (FHIR)
    • STU3
    • Financial Mgmt
    • (many)
    • Hide

      Add text:
      While the ideal solution is to have the provider send the required documentation with the claim, there currently (and for the forseeable future) is the need for the payer to request documentation to support and/or audit the medical necessity of a claim.

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      Add text: While the ideal solution is to have the provider send the required documentation with the claim, there currently (and for the forseeable future) is the need for the payer to request documentation to support and/or audit the medical necessity of a claim.
    • Robert Dieterle / Jay Lyle: 3-0-2
    • Clarification
    • Non-substantive

      Proposed Wording: Ideally, this process/transaction would not be needed if the provider knows WHEN medical documentation is needed to support a claim and WHAT information is needed AHEAD OF TIME and can be sent to payer with claim. While this transaction to support medical necessity documentation is currently needed, the fact that is being done is perpetuating a pervasive process that can be corrected and solved in advance, proactively, rather than in the backside, retroactively.

      Summary:

      The process/transaction would not be needed if the provider knows WHEN document is needed.

            Assignee:
            Unassigned
            Reporter:
            Walter Suarez
            Watchers:
            3 Start watching this issue

              Created:
              Updated:
              Resolved: