Section 1c: FHIR®
HL7 FHIR® Implementation Guide: Coverage Requirements Discovery (CRD), Release 1 - US Realm
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.
HL7 FHIR® Implementation Guide: Coverage Requirements Discovery (CRD), Release 1 - US Realm may also go by the following names or acronyms:
- 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.
- Reference implementation created by MITRE.
- Test implementation by Mettle Solutions
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.
RESPONSIBLE WORK GROUP
- Implementation Guide
- US Realm