Prior authorization workflows should focus on directly connecting EHRs to health plans - PAS #116

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    • Type: Change Request
    • Resolution: Not Persuasive
    • Priority: Medium
    • US Da Vinci PAS (FHIR)
    • STU3
    • Financial Mgmt
    • (profiles) [deprecated]
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      The purpose of PAS is to provide an 'easier' mechanism for EHR systems to solicit prior authorizations where those EHRs have not already implemented the X12 278 and 275 interactions. We have indications that at least some EHRs would like to implement this way.

      Where EHRs are already capable of using 278 and 275 directly, they're free to continue to do so. There is no need to introduce a parallel FHIR representation and no need to have an intermediary. The additional format (and resulting translation) are justified by increasing the likelihood of prior authorizations being initiated from within EHRs where they're not right now.

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      The purpose of PAS is to provide an 'easier' mechanism for EHR systems to solicit prior authorizations where those EHRs have not already implemented the X12 278 and 275 interactions. We have indications that at least some EHRs would like to implement this way. Where EHRs are already capable of using 278 and 275 directly, they're free to continue to do so. There is no need to introduce a parallel FHIR representation and no need to have an intermediary. The additional format (and resulting translation) are justified by increasing the likelihood of prior authorizations being initiated from within EHRs where they're not right now.
    • Mark Scrimshire / Mary Kay McDaniel: 19-0-0

      Comment:

      Prior authorization workflows should focus on directly connecting EHRs to health plans rather than working towards supporting clearing houses to transfrom messages. We should either be focusing on increasing 278 adoption and making a more standard interpretation of the HIPAA compliant specification or looking to get another standard (FHIR Claim) to be HIPAA compliant rather than adding complexity through transforms.

      Summary:

      Prior authorization workflows should focus on directly connecting EHRs to health plans

            Assignee:
            Unassigned
            Reporter:
            Michael Clifton
            Watchers:
            2 Start watching this issue

              Created:
              Updated:
              Resolved: