Clarify what "active treatment" means in the payer world. - PCDE #69

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    • Type: Change Request
    • Resolution: Persuasive with Modification
    • Priority: Medium
    • US Da Vinci PCDE (FHIR)
    • STU3
    • Financial Mgmt
    • (profiles) [deprecated]
    • 4.3.1.1.1
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      We don't expect that payers will necessarily have CarePlan instances in their systems at all. CarePlan is simply a convenient mechanism for organizing the data a payer does have into 'treatments'. That said, we will better define 'active' - specifically, that it means "a treatment that, to the best of the payer's knowlege, is believed to be ongoing and for which the new payer might reasonably expect prior authorizations or claims".

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      We don't expect that payers will necessarily have CarePlan instances in their systems at all. CarePlan is simply a convenient mechanism for organizing the data a payer does have into 'treatments'. That said, we will better define 'active' - specifically, that it means "a treatment that, to the best of the payer's knowlege, is believed to be ongoing and for which the new payer might reasonably expect prior authorizations or claims".
    • Kathleen Connor / Rachael Foerster: 20-0-1
    • Clarification
    • Non-substantive

      Comment:

      Clarify what "active treatment" measns in the payer world and whether the presence of a FHIR Care Plan with an "active" status is all that is needed to indicate that. Are there instances where an "active" Care Plan would not actually contain active treatment? If so clarify how to use active status to reflect correct content.

      Summary:

      Clarify what "active treatment" means in the payer world.

            Assignee:
            Unassigned
            Reporter:
            jskapik
            Watchers:
            3 Start watching this issue

              Created:
              Updated:
              Resolved: