If payers aren't using FHIR, how can we be sure that all of the info will be processed and usable by payer? - PAS #201

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    • Type: Change Request
    • Resolution: Not Persuasive
    • Priority: Medium
    • US Da Vinci PAS (FHIR)
    • STU3
    • Financial Mgmt
    • (profiles) [deprecated]
    • Formal Specification
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      The elements are marked as 'mustSupport' if they're going to pass through X12. This part of the specification allows for data to be present that won't be converted to X12. I.e. It allows providers to send out resources in their 'standard' way (filtered to only include data that the payer is allowed to see), instead of prohibiting them from sending data that the payer would likely ignore - which incurs an ongoing maintenance cost for a custom id.

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      The elements are marked as 'mustSupport' if they're going to pass through X12. This part of the specification allows for data to be present that won't be converted to X12. I.e. It allows providers to send out resources in their 'standard' way (filtered to only include data that the payer is allowed to see), instead of prohibiting them from sending data that the payer would likely ignore - which incurs an ongoing maintenance cost for a custom id.
    • Kathleen Connor / Robert Dieterle: 20-0-1

      Existing Wording: FHIR elements not marked as 'must support' MAY be included in resources within the Bundle, but client systems should have no expectation of such elements being processed by the payer unless prior arrangements have been made

      Comment:

      If payers aren't using FHIR, how can we be sure that all of the info will be processed and usable by payer? If needed info isn't marked "must support" in FHIR, does that mean the payer may not be able to see it. Are we sure everything needed will be supported? Otherwise, this is going to generate follow-up queries and clinical info being sent by other means.

      Summary:

      If payers aren't using FHIR, how can we be sure that all of the info will be processed and usable by payer?

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

              Created:
              Updated:
              Resolved: