Section 1e: Version 3 (V3)
Section 2: Clinical and Administrative Domains
HL7 Version 3 Standard: Claims & Reimbursement
DESCRIPTION
The HL7 Version 3 Claims and Reimbursements Messaging Standard, retired in 2022, provides non-US realm support for generic, pharmacy, preferred accommodation, physician, oral health, vision care and hospital claims for eligibility, authorization, coverage extension, pre-determination, invoice adjudication, payment advice and Statement of Financial Activity (SOFA). Release 3 of this document adds claims messaging support for physician, oral health, vision care and hospital claims.
ALTERNATIVE NAMES
HL7 Version 3 Standard: Claims & Reimbursement may also go by the following names or acronyms:
"Reaffirmation of HL7 Version 3 Standard: Claims and Reimbursement, Release 4", "V3: Claims and Reimbursement, R2", "V3: Claims and Reimbursement, R3", "V3: Cliams and Reimbursement, R4", C&R, CR
TARGETS
- Healthcare Institutions (hospitals, long term care, home care, mental health)
- Healthcare IT Vendors
- Payers
- Local and State Departments of Health
BENEFITS
- Facilitates the adoption of electronic health records across the healthcare industry by automating the capture of patient eligibility information necessary to ensure coverage for services provided; automating the generation and receipt of pre-determination and prior authorization information for requested services; automating the generation of invoice details about services rendered, and remittance advice, which are necessary data feeds into claims generation and adjudication process.
IMPLEMENTATIONS/CASE STUDIES
- Infoway sponsored this work for implementation in Canada
DEVELOPMENT BACKGROUND
RELATED DOCUMENTS
 |
HL7 Version 3 Standard: Claims & Reimbursement |
(Download) (189.07 MB) |
TOPIC
- Financial Management
BALLOT TYPE
- Normative
STATUS DATE
2012-06-05RESPONSIBLE WORK GROUP
STAKEHOLDERS
- Healthcare Institutions
- Local and State Departments of Health
FAMILY
- V3
CURRENT STATE
- Retired
REALM
- Universal