HL7 FHIR® Implementation Guide: Coverage Requirements Discovery (CRD), Release 1 - US Realm

DESCRIPTION

Provides a mechanism for healthcare providers to discover guidelines, pre-authorization requirements and other expectations from payor organizations related to a proposed medication, procedure or other service associated with a patient's insurance coverage. Supports both patient-specific and patient-independent information retrieval.

ALTERNATIVE NAMES

HL7 FHIR® Implementation Guide: Coverage Requirements Discovery (CRD), Release 1 - US Realm may also go by the following names or acronyms:

BENEFITS

• Ensures providers are aware of payer-specific requirements at the time of decision-making.
• Reduces provider burden by simplifying prior authorization processes.
• Allows awareness of coverage to be considered as part of planning patient care.

IMPLEMENTATIONS/CASE STUDIES

• Reference implementation created by MITRE.
• Test implementation by Mettle Solutions

DEVELOPMENT BACKGROUND

This specification was created as part of the Da Vinci project with significant participation from the U.S. Payer community as well as several EHR software vendors.

RELATED DOCUMENTS

HL7 FHIR® Implementation Guide: Coverage Requirements Discovery (CRD), Release 1 - US Realm

STU DOCUMENTS

HL7 FHIR® Implementation Guide: Coverage Requirements Discovery (CRD), Release 1 - US Realm http://hl7.org/fhir/us/davinci-crd/STU1/index.html

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BALLOT TYPE

• STU

STATUS DATE

2020-12-22

RESPONSIBLE WORK GROUP

PRODUCT TYPE

• Implementation Guide

FAMILY

• FHIR

CURRENT STATE

• Active

REALM

• US Realm