Expand scope of member-match

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    • Type: Change Request
    • Resolution: Persuasive with Modification
    • Priority: Highest
    • US Da Vinci HRex (FHIR)
    • current
    • Clinical Interoperability Council
    • HRex Member Match Operation
    • HRex Member Match Operation
    • Hide

      We will revise the operation as follows:

      • In the request and response we will make the 'new Coverage' optional.
      • We will add a conformance rule that mandates that the 'new Coverage' is mandatory when requests are being made by a payer who has Coverage for the member
      • We will update the documentation about the operation indicating that, when new Coverage is present, the target payer SHOULD create an association in their system between the two Coverage records in addition to returning the member id
      • We will update the metadata of the operation to indicate that it can change data.
      • Will expand the description to include provider lookup as one of the use-cases.

       

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      We will revise the operation as follows: In the request and response we will make the 'new Coverage' optional. We will add a conformance rule that mandates that the 'new Coverage' is mandatory when requests are being made by a payer who has Coverage for the member We will update the documentation about the operation indicating that, when new Coverage is present, the target payer SHOULD create an association in their system between the two Coverage records in addition to returning the member id We will update the metadata of the operation to indicate that it can change data. Will expand the description to include provider lookup as one of the use-cases.  
    • Marti Velezis / Jimmy Tcheng : 6-0-1
    • Enhancement
    • Compatible, substantive

      The HReX profile states that it is intended as a "is a foundational guide for all other Da Vinci guides. It defines FHIR profiles, operations and guidance that are relevant to more than one, and sometimes all, Da Vinci use-case IGs."
      Given that Da Vinci IGs cover use cases beyond payer to payer communications, I think this operation needs to be more flexible and allow the client to be a healthcare organization, or the member themselves. This will require changing the list and/or cardinality of the parameter.

            Assignee:
            Unassigned
            Reporter:
            Vassil Peytchev
            Vassil Peytchev
            Watchers:
            2 Start watching this issue

              Created:
              Updated:
              Resolved: