The plan should assemble the information needed using available info within their own system. - PCDE #123

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    • Type: Change Request
    • Resolution: Persuasive
    • Priority: Medium
    • US Da Vinci PCDE (FHIR)
    • STU3
    • Financial Mgmt
    • (profiles) [deprecated]
    • 4.2.2
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      Will make it clear that the expectation is that the data in the document is expected to be assembled from existing data the 'old' payer already has custody of, not via retrieval of information from provider or other payer systems. What data must be assembled is governed by regulation and/or inter-payer agreement.

      Will also make clear that a PCDE request must be satisfied by the document exchange, not by fax, phone call, etc.

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      Will make it clear that the expectation is that the data in the document is expected to be assembled from existing data the 'old' payer already has custody of, not via retrieval of information from provider or other payer systems. What data must be assembled is governed by regulation and/or inter-payer agreement. Will also make clear that a PCDE request must be satisfied by the document exchange, not by fax, phone call, etc.
    • Mark Scrimshire / Mary Kay McDaniel: 17-0-2
    • Clarification
    • Non-substantive

      Existing Wording: Using the token, the new payer's system requests a Coverage Transition document from the prior plan. The prior plan either locates an existing document (previously prepared) or assembles the information needed and creates the document

      Comment:

      This section should make clear that the plan should assemble the information needed using available info within their own system. It is currently ambiguous as to how the plan will assemble the information used when creating a document. Plans should not reach out to providers to pull information unless explicitly directed by the patient.

      Summary:

      The plan should assemble the information needed using available info within their own system.

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

              Created:
              Updated:
              Resolved: