Providers and payers must collaboratively determine whether the information requested by payers for prior authorization support is the minimum necessary - PAS #26

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    • Type: Change Request
    • Resolution: Persuasive
    • Priority: Medium
    • US Da Vinci PAS (FHIR)
    • STU3
    • Financial Mgmt
    • (profiles) [deprecated]
    • Hide

      In the Privacy & Security Considerations section of the IG, add a line saying:

      The sharing of information from provider to payer for determining prior authorization is subject to HIPAA's "minimum necessary" regulations (specifically 45 CFR 164.514(d)(3) and (d)(4)). Payers are responsible for ensuring that only information necessary to make the prior authorization decision is solicited and providers are responsible for ensuring that only data that is reasonably relevant to the prior authorization decision is transmitted.

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      In the Privacy & Security Considerations section of the IG, add a line saying: The sharing of information from provider to payer for determining prior authorization is subject to HIPAA's "minimum necessary" regulations (specifically 45 CFR 164.514(d)(3) and (d)(4)). Payers are responsible for ensuring that only information necessary to make the prior authorization decision is solicited and providers are responsible for ensuring that only data that is reasonably relevant to the prior authorization decision is transmitted.
    • Robert Dieterle / Rachael Foerster: 20-0-1
    • Clarification
    • Non-substantive

      Existing Wording: No existing wording related to automatic techniques for filtering for minimum necessary information or security labels.

      Comment:

      In addition to needing to include pertinent HIPAA Privacy guidance related to PAS, this IG must also include automated techniques for filtering provider disclosures and payer requests in accordance with 45 CFR 164.514(d)(3) and (d)(4).

      Summary:

      Providers and payers must collaboratively determine whether the information requested by payers for prior authorization support is the minimum necessary

            Assignee:
            Unassigned
            Reporter:
            Kathleen Connor
            Watchers:
            3 Start watching this issue

              Created:
              Updated:
              Resolved: