HL7 CDA® Release 2 Implementation Guide: Additional CDA R2 Templates – Clinical Documents for Payers Set 1, Release 1 – US Realm

DESCRIPTION

The purpose of this implementation guide (IG) is to provide guidance on a standardized, implementable, interoperable electronic solution to reduce the time and expense related to the exchange of clinical and administrative information between and among providers and payers. This guide describes structured documentation templates that meet requirements for documentation of medical necessity and appropriateness of services to be delivered or that have been delivered in the course of patient care.

These document templates are designed for use when the provider needs to exchange more clinical information than is required by the C-CDA R2 document-level templates and/or must indicate why information for specific section-level or entry-level templates is not included. For example, payer policy may allow providers to submit any information they feel substantiates that a service is medically necessary and appropriate under the applicable coverage determination rules. The ability to submit any supporting documentation is a provider’s right under these rules as is the ability to declare that specific information is not available or not applicable.

ALTERNATIVE NAMES

HL7 CDA® Release 2 Implementation Guide: Additional CDA R2 Templates – Clinical Documents for Payers Set 1, Release 1 – US Realm may also go by the following names or acronyms:

TARGETS

• Payers
• EHR, PHR Vendors
• Medicare

BENEFITS

• Provides guidance for a standardized, implementable, interoperable electronic solution to reduce the time and expense related to the exchange of clinical and administrative information between and among providers and payers
• Allows providers to submit any information they feel substantiates that a service is medically necessary and appropriate under the applicable coverage determination rules

IMPLEMENTATIONS/CASE STUDIES

• Medicare

DEVELOPMENT BACKGROUND

This guide is the result of a joint effort of the HL7 Attachments Work Group, the HL7 Structured Documents Work Group, the Centers for Medicare & Medicaid Services (CMS), and the Office of the National Coordinator (ONC) Standards and Interoperability (S&I) Framework Electronic Submission of Medical Documentation (esMD) Initiative.

RELATED DOCUMENTS

HL7 CDA® Release 2 Implementation Guide: Additional CDA R2 Templates – Clinical Documents for Payers Set 1, Release 1 – US Realm

STU DOCUMENTS

HL7 CDA® R2 IG: Additional CDA R2 Templates - Clinical Documents for Payers – Set 1, Release 1 – US Realm

Expiration Sep 2017

(Download) (3.26 MB)

TOPIC

• Attachments

BALLOT TYPE

• DSTU

STATUS DATE

2020-08-07

RESPONSIBLE WORK GROUP

STAKEHOLDER

• EHR, PHR Vendors

FAMILY

• CDA

CURRENT STATE

• Retired

REALM

• US Realm