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FHIR IG Statistics: Requirements/EHRSFMR2-AS.8.3

Packagehl7.ehrs.uv.ehrsfmr2
TypeRequirements
IdEHRSFMR2-AS.8.3
FHIR VersionR5
Sourcehttp://hl7.org/ehrs/uv/ehrsfmr2/https://build.fhir.org/ig/mvdzel/ehrsfm-fhir-r5/Requirements-EHRSFMR2-AS.8.3.html
URLhttp://hl7.org/ehrs/uv/ehrsfmr2/Requirements/EHRSFMR2-AS.8.3
Version2.1.1-ballot
Statusactive
Date2025-05-13T15:11:00+00:00
NameAS_8_3_Support_Integration_of_Cost_Financial_information_into_Patient_Care
TitleAS.8.3 Support Integration of Cost/Financial information into Patient Care (Function)
Realmuv
Authorityhl7
DescriptionSupport interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows.
PurposeThe 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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Narrative

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Statement N:

Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows.

Description I:

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.

Actors:
ehr
Criteria N:
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.


Source

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  "resourceType": "Requirements",
  "id": "EHRSFMR2-AS.8.3",
  "meta": {
    "profile": [
      "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/FMFunction"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "ehr"
    }
  ],
  "url": "http://hl7.org/ehrs/uv/ehrsfmr2/Requirements/EHRSFMR2-AS.8.3",
  "version": "2.1.1-ballot",
  "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": "2025-05-13T15:11:00+00:00",
  "publisher": "HL7 International / Electronic Health Records",
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/ehr"
        }
      ]
    }
  ],
  "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": [
    {
      "extension": [
        {
          "url": "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
          "valueBoolean": false
        }
      ],
      "key": "EHRSFMR2-AS.8.3-01",
      "label": "AS.8.3#01",
      "conformance": [
        "MAY"
      ],
      "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": [
        {
          "url": "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
          "valueBoolean": false
        }
      ],
      "key": "EHRSFMR2-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": [
        {
          "url": "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
          "valueBoolean": false
        }
      ],
      "key": "EHRSFMR2-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": [
        {
          "url": "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
          "valueBoolean": false
        }
      ],
      "key": "EHRSFMR2-AS.8.3-04",
      "label": "AS.8.3#04",
      "conformance": [
        "MAY"
      ],
      "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.",
      "derivedFrom": "EHR-S_FM_R1.1 S.3.2.3#3"
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
          "valueBoolean": false
        }
      ],
      "key": "EHRSFMR2-AS.8.3-05",
      "label": "AS.8.3#05",
      "conformance": [
        "MAY"
      ],
      "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": [
        {
          "url": "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
          "valueBoolean": false
        }
      ],
      "key": "EHRSFMR2-AS.8.3-06",
      "label": "AS.8.3#06",
      "conformance": [
        "SHOULD"
      ],
      "conditionality": false,
      "requirement": "The system SHOULD conform to function [AS.9.3](Requirements-EHRSFMR2-AS.9.3.html) (Support Service Authorizations) to integrate support of prior authorization processes.",
      "derivedFrom": "EHR-S_FM_R1.1 S.3.2.3#5"
    }
  ]
}