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

2012-06-05

RESPONSIBLE WORK GROUP

Financial Management

STAKEHOLDERS

  • Healthcare Institutions
  • Local and State Departments of Health

FAMILY

  • V3

CURRENT STATE

  • Retired

REALM

  • Universal