| Package | hl7.ehrs.ehrsfmr21 |
| Type | Requirements |
| Id | Id |
| FHIR Version | R5 |
| Source | http://hl7.org/ehrs/https://build.fhir.org/ig/mvdzel/ehrsfm-fhir-r5/Requirements-EHRSFMR2.1-AS.8.3.html |
| Url | http://hl7.org/ehrs/Requirements/EHRSFMR2.1-AS.8.3 |
| Version | 2.1.0 |
| Status | active |
| Date | 2024-11-26T16:30:50+00:00 |
| Name | AS_8_3_Support_Integration_of_Cost_Financial_information_into_Patient_Care |
| Title | AS.8.3 Support Integration of Cost/Financial information into Patient Care (Function) |
| Experimental | False |
| Realm | uv |
| Authority | hl7 |
| Description | Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows. |
| Purpose | The provider is alerted or presented with the most cost-effective services, referrals, devices, etc., to recommend to the patient. This may be tailored to the patient's health insurance/plan coverage rules. Medications may be presented in order of cost, or the cost of specific interventions may be presented at the time of ordering. |
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Note: links and images are rebased to the (stated) source
Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows.
The provider is alerted or presented with the most cost-effective services, referrals, devices, etc., to recommend to the patient. This may be tailored to the patient's health insurance/plan coverage rules. Medications may be presented in order of cost, or the cost of specific interventions may be presented at the time of ordering.
| AS.8.3#01 | MAY |
The system MAY provide the ability to extract formularies, preferred providers, and other information, from internal or external sources, that are associated with a patient's health care plan and coverage so that the provider can offer cost effective alternatives to patients. |
| AS.8.3#02 | MAY |
The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines. |
| AS.8.3#03 | MAY |
The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines. |
| AS.8.3#04 | MAY |
The system MAY provide the ability to render expected patient out-of- pocket cost information for medications, diagnostic testing, and procedures, from internal or external sources, that are associated with a patients health care plan and coverage. |
| AS.8.3#05 | MAY |
The system MAY provide the ability to render a notification of an alert to the provider of care where formularies, preferred provider and other information indicate the health plan requires an alternative. |
| AS.8.3#06 | SHOULD |
The system SHOULD conform to function [[AS.9.3]] (Support Service Authorizations) to integrate support of prior authorization processes. |
FHIR{
"resourceType" : "Requirements",
"id" : "EHRSFMR2.1-AS.8.3",
"meta" : {
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"http://hl7.org/ehrs/StructureDefinition/FMFunction"
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <span id=\"description\"><b>Statement <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Normative Content\" class=\"normative-flag\">N</a>:</b> <div><p>Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows.</p>\n</div></span>\n\n \n <span id=\"purpose\"><b>Description <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Informative Content\" class=\"informative-flag\">I</a>:</b> <div><p>The provider is alerted or presented with the most cost-effective services, referrals, devices, etc., to recommend to the patient. This may be tailored to the patient's health insurance/plan coverage rules. Medications may be presented in order of cost, or the cost of specific interventions may be presented at the time of ordering.</p>\n</div></span>\n \n\n \n\n \n <span id=\"requirements\"><b>Criteria <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Normative Content\" class=\"normative-flag\">N</a>:</b></span>\n \n <table id=\"statements\" class=\"grid dict\">\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>AS.8.3#01</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n \n <span>MAY</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>The system MAY provide the ability to extract formularies, preferred providers, and other information, from internal or external sources, that are associated with a patient's health care plan and coverage so that the provider can offer cost effective alternatives to patients.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>AS.8.3#02</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n \n <span>MAY</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>AS.8.3#03</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n \n <span>MAY</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>AS.8.3#04</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n \n <span>MAY</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>The system MAY provide the ability to render expected patient out-of- pocket cost information for medications, diagnostic testing, and procedures, from internal or external sources, that are associated with a patients health care plan and coverage.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>AS.8.3#05</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n \n <span>MAY</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>The system MAY provide the ability to render a notification of an alert to the provider of care where formularies, preferred provider and other information indicate the health plan requires an alternative.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n <tr>\n <td style=\"padding-left: 4px;\">\n \n <span>AS.8.3#06</span>\n \n </td>\n <td style=\"padding-left: 4px;\">\n \n \n \n <span>SHOULD</span>\n \n </td>\n <td style=\"padding-left: 4px;\" class=\"requirement\">\n \n <span><div><p>The system SHOULD conform to function [[AS.9.3]] (Support Service Authorizations) to integrate support of prior authorization processes.</p>\n</div></span>\n \n \n </td>\n </tr>\n \n </table>\n</div>"
},
"url" : "http://hl7.org/ehrs/Requirements/EHRSFMR2.1-AS.8.3",
"version" : "2.1.0",
"name" : "AS_8_3_Support_Integration_of_Cost_Financial_information_into_Patient_Care",
"title" : "AS.8.3 Support Integration of Cost/Financial information into Patient Care (Function)",
"status" : "active",
"date" : "2024-11-26T16:30:50+00:00",
"publisher" : "EHR WG",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/ehr"
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]
}
],
"description" : "Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
"code" : "001",
"display" : "World"
}
]
}
],
"purpose" : "The provider is alerted or presented with the most cost-effective services, referrals, devices, etc., to recommend to the patient. This may be tailored to the patient's health insurance/plan coverage rules. Medications may be presented in order of cost, or the cost of specific interventions may be presented at the time of ordering.",
"statement" : [
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"extension" : [
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"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-AS.8.3-01",
"label" : "AS.8.3#01",
"conformance" : [
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],
"conditionality" : false,
"requirement" : "The system MAY provide the ability to extract formularies, preferred providers, and other information, from internal or external sources, that are associated with a patient's health care plan and coverage so that the provider can offer cost effective alternatives to patients.",
"derivedFrom" : "EHR-S_FM_R1.1 S.3.2.3#1"
},
{
"extension" : [
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"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-AS.8.3-02",
"label" : "AS.8.3#02",
"conformance" : [
"MAY"
],
"conditionality" : false,
"requirement" : "The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines.",
"derivedFrom" : "EHR-S_FM_R1.1 S.3.2.3#2"
},
{
"extension" : [
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"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-AS.8.3-03",
"label" : "AS.8.3#03",
"conformance" : [
"MAY"
],
"conditionality" : false,
"requirement" : "The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines."
},
{
"extension" : [
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"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-AS.8.3-04",
"label" : "AS.8.3#04",
"conformance" : [
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"conditionality" : false,
"requirement" : "The system MAY provide the ability to render expected patient out-of- pocket cost information for medications, diagnostic testing, and procedures, from internal or external sources, that are associated with a patients health care plan and coverage.",
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{
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"key" : "EHRSFMR2.1-AS.8.3-05",
"label" : "AS.8.3#05",
"conformance" : [
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],
"conditionality" : false,
"requirement" : "The system MAY provide the ability to render a notification of an alert to the provider of care where formularies, preferred provider and other information indicate the health plan requires an alternative.",
"derivedFrom" : "EHR-S_FM_R1.1 S.3.2.3#4"
},
{
"extension" : [
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"url" : "http://hl7.org/ehrs/StructureDefinition/requirements-dependent",
"valueBoolean" : false
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],
"key" : "EHRSFMR2.1-AS.8.3-06",
"label" : "AS.8.3#06",
"conformance" : [
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],
"conditionality" : false,
"requirement" : "The system SHOULD conform to function [[AS.9.3]] (Support Service Authorizations) to integrate support of prior authorization processes.",
"derivedFrom" : "EHR-S_FM_R1.1 S.3.2.3#5"
}
]
}
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