Existing Wording: This will be done by querying the payer system/intermediary. This might be done at regular intervals (polling) or it might be done in response to a subscription notification indicating that the prior authorization has been changed

Comment:

One of the continual issues with the 278 that has been expressed by industry stakeholders is the inability of some payers to answer a previously pended response decision has been made. By creating a situation where the onus is on the provider's system to check on payer status for a prior authorization, this is just replicating current problems with payers sending unsolicited 278 with final PA decision - this should be fixed, not built into the new FHIR system.

Summary:

This is just replicating current problems with payers sending unsolicited 278 with final PA decision - this should be fixed, not built into the new FHIR system.