![]() ![]() This implementation guide supports both Protected Health Information (PHI)-specific and non-PHI mechanisms for CRD to meet the needs and privileges of different payer organizations. This will ensure that clinicians and administrative staff have the capability to make informed decisions and meet the requirements of the patient’s insurance coverage. This Coverage Requirements Discovery (CRD) implementation guide defines a workflow to allow payers to provide information about coverage requirements to healthcare providers through their clinical systems at the time treatment decisions are being made. The outcome of this failure to conform to payer requirements can be: increased out of pocket costs for patients, additional visits, changes to ordered therapy and increased costs for both patients and providers. Providers who fail to adhere to payer or coverage expectations may find that costs for a given service are not covered or are only partially covered. Different processess have different requirements for documentation, prior authorization or other approvals. Different payers and plans provide different levels of coverage for healthcare services with different processes for determining whether services are necessary or are appropriate. Healthcare providers work with a range of different health insurers and payers who cover the services the providers supply to patients. The process of managing billing for patient insurance is a significant source of complexity and cost in the United States. Individuals interested in participating in the Coverage Requirements Discovery or other HL7 Da Vinci projects can find information about Da Vinci (). Feedback on the US core profiles should be submitted to the FHIR change tracker with "US Core" as the specification.Feedback on the FHIR core specification should be submitted to the FHIR change tracker with "FHIR Core" as the specification.Feedback on CDS Hooks should be posted to the CDS Hooks GitHub Issue List.Please submit any comments you have on these base specifications as follows: ![]() This implementation guide is dependent on other specifications. It is expected to continue to evolve and improve through connectathon testing and feedback from early adopters.įeedback is welcome and may be submitted through the FHIR change tracker indicating "US Da Vinci CRD" as the specification. This specification is a Standard for Trial Use. ![]()
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