It should not be a requirement that payors transform materials received from authorative sources. - PCDE #94

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    • Type: Change Request
    • Resolution: Persuasive with Modification
    • Priority: Medium
    • US Da Vinci PCDE (FHIR)
    • STU3
    • Financial Mgmt
    • (profiles) [deprecated]
    • 4.3.2
    • Hide

      Some of this is no longer relevant due to changes to US Core

      Adjust this language to reflect only the conversion of NDC or HCPCS drug codes codes to RxNorm when exposing data as MedicationStatement/MedicationRequest. Note that exposing payer information using these resources is not mandatory. This will not apply when exposing data using Claim or ClaimResponse (e.g. claims, prior authorizations, pre-determinations) as those aren't U.S. Core profiles.

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      Some of this is no longer relevant due to changes to US Core Adjust this language to reflect only the conversion of NDC or HCPCS drug codes codes to RxNorm when exposing data as MedicationStatement/MedicationRequest. Note that exposing payer information using these resources is not mandatory. This will not apply when exposing data using Claim or ClaimResponse (e.g. claims, prior authorizations, pre-determinations) as those aren't U.S. Core profiles.
    • Robert Dieterle / Mary Kay McDaniel: 20-0-1
    • Correction
    • Compatible, substantive

      Existing Wording: The US Core profiles impose terminology expectations that reflect commonly used clinical terminologies. These may not always align with commonly used billing codes. While billing codes may be sent as well (as additional translations), payers SHALL translate to the appropriate clinical terminology (e.g. SNOMED CT) in order to comply with the US Core profiles if an appropriate code exists in the US Core value set.

      Comment:

      This is a payor to payor not a payor to provider data exchange, so while payors may supply clinical terminologies if they receive data in clinical terminologies or are prepared to map, it should not be a requirement that payors transform materials received from authorative sources.

      Summary:

      It should not be a requirement that payors transform materials received from authorative sources.

            Assignee:
            Unassigned
            Reporter:
            Paul Knapp
            Watchers:
            4 Start watching this issue

              Created:
              Updated:
              Resolved: