In order to clarify, the IG should include verbiage that requires the payer to specify what information was missing that led to the rejection - PAS #189

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    • Type: Change Request
    • Resolution: Persuasive with Modification
    • Priority: Medium
    • US Da Vinci PAS (FHIR)
    • STU3
    • Financial Mgmt
    • (profiles) [deprecated]
    • Use Cases and Overvi
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      Will change "However, in some cases an authorization might be rejected due to insufficient information.  In this case, a new authorization can be submitted with additional information supplied to support the decision-making process." to

      "However, in some cases an authorization will have a status of denied or pended due to insufficient information, which will normally be indicated either by error messages indicating which mandatory elements were missing or with a request for specific additional information to be provided.  In this case, a new or revised authorization can be submitted with additional information supplied to support the decision-making process." 

      Alternative solutions are to upload the additional information to the payers portal or have the payer use DTR to collect missing information

       

      Created, reviewed and approved diagram to represent options for additional documentation. Will include in the final IG

       

       

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      Will change "However, in some cases an authorization might be rejected due to insufficient information.  In this case, a new authorization can be submitted with additional information supplied to support the decision-making process." to "However, in some cases an authorization will have a status of denied or pended due to insufficient information, which will normally be indicated either by error messages indicating which mandatory elements were missing or with a request for specific additional information to be provided.  In this case, a new or revised authorization can be submitted with additional information supplied to support the decision-making process."  Alternative solutions are to upload the additional information to the payers portal or have the payer use DTR to collect missing information   Created, reviewed and approved diagram to represent options for additional documentation. Will include in the final IG    
    • Robert Dieterle / Mark Scrimshire : 17-0-0
    • Enhancement
    • Non-substantive

      Existing Wording: However, in some cases an authorization might be rejected due to insufficient information .

      Comment:

      In order to clarify, the IG should include verbiage that requires the payer to specify what information was missing that led to the rejection

      Summary:

      In order to clarify, the IG should include verbiage that requires the payer to specify what information was missing that led to the rejection

            Assignee:
            Unassigned
            Reporter:
            Terrence Cunningham
            Watchers:
            5 Start watching this issue

              Created:
              Updated:
              Resolved: