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1a. Project Name

CARIN IG for Digital Insurance Card

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact being Reaffirmed or proceeding to Normative directly after being either Informative or STU?

No

1e. Today's Date

1f. Name of standard being reaffirmed

1g. Project Artifact Information

1h. ISO/IEC Standard to Adopt

1i. Does the standard include excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption?

1j. Unit of Measure

2a. Primary/Sponsor WG

Payer/Provider Information Exchange

2b. Co-Sponsor WG

Financial Management

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballot

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2e. Other Interested Parties (and roles)

Vocabulary

2f. Modeling Facilitator

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Cille Kissel, Mark Roberts, Adam Culbertson

2i. Domain Expert Representative

2j. Business Requirements Analyst

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2l. Other Facilitators

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will request approval from the US Realm Steering Committee, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable

Attachments

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3d. External Drivers

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
1/2022 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID, Digital Insurance Card

3g. Lineage

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/CAR/CARIN+IG+for+Digital+Membership+ID

3j. Backwards Compatibility

N/A

3k. Additional Backwards Compatibility Information (if applicable)

3l. Using Current V3 Data Types?

N/A

3l. Reason for not using current V3 data types?

3m. External Vocabularies

N/A

3n. List of Vocabularies

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

4c. FHIR Profiles Version

4d. Please define your New Product Definition

4d. Please define your New Product Family

5a. Project Intent

Supplement to a current standard

5a. White Paper Type

5a. Is the project adopting/endorsing an externally developed IG?

5a. Externally developed IG is to be (select one)

5a. Specify external organization

5a. Revising Current Standard Info

5b. Project Ballot Type

STU to Normative

5c. Additional Ballot Info

5d. Joint Copyright

No

5e. I understand I must submit a Joint Copyright Letter of Agreement to the TSC in order for the PSS to receive TSC approval.

no

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6g. Other Vendors

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6h. Other Providers

6i. Realm

U.S. Realm Specific

7d. US Realm Approval Date

Apr 06, 2021

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

7c. Co-Sponsor Approval Date

Apr 06, 2021

7c. Co-Sponsor 2 Approval Date

7c. Co-Sponsor 3 Approval Date

7c. Co-Sponsor 4 Approval Date

7c. Co-Sponsor 5 Approval Date

7c. Co-Sponsor 6 Approval Date

7c. Co-Sponsor 7 Approval Date

7c. Co-Sponsor 8 Approval Date

7c. Co-Sponsor 9 Approval Date

7c. Co-Sponsor 10 Approval Date

7e. CDA MG Approval Date

7f. FMG Approval Date

Apr 07, 2021

7g. V2 MG Approval Date

7h. Architecture Review Board Approval Date

7i. Steering Division Approval Date

Apr 19, 2021

7j. TSC Approval Date

May 03, 2021


Version

17

Modifier

Anne Wizauer

Modify Date

May 07, 2021 20:49

1a. Project Name

CARIN IG for Digital Insurance Card

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2b. Co-Sponsor WG

Financial Management

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballot

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2e. Other Interested Parties (and roles)

Vocabulary

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Cille Kissel, Mark Roberts, Adam Culbertson

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will request approval from the US Realm Steering Committee, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
1/2022 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID, Digital Insurance Card

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/CAR/CARIN+IG+for+Digital+Membership+ID

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

7c. Co-Sponsor Approval Date

Apr 06, 2021

7d. US Realm Approval Date

Apr 06, 2021

7f. FMG Approval Date

Apr 07, 2021

7i. Steering Division Approval Date

Apr 19, 2021

7j. TSC Approval Date

May 03, 2021

Version

16

Modifier

Mark Roberts

Modify Date

Apr 21, 2021 13:52

1a. Project Name

CARIN IG for Digital Insurance Card

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2b. Co-Sponsor WG

Financial Management

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballot

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2e. Other Interested Parties (and roles)

Vocabulary

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Cille Kissel, Mark Roberts, Adam Culbertson

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will request approval from the US Realm Steering Committee, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
1/2022 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID, Digital Insurance Card

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/CAR/CARIN+IG+for+Digital+Membership+ID

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

7c. Co-Sponsor Approval Date

Apr 06, 2021

7d. US Realm Approval Date

Apr 06, 2021

7f. FMG Approval Date

Apr 07, 2021

7i. Steering Division Approval Date

Apr 19, 2021

Version

15

Modifier

Mark Roberts

Modify Date

Apr 15, 2021 20:36

1a. Project Name

CARIN IG for Digital Insurance Card

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2b. Co-Sponsor WG

Financial Management

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballot

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2e. Other Interested Parties (and roles)

Vocabulary

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Cille Kissel, Mark Roberts, Adam Culbertson

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will request approval from the US Realm Steering Committee, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
1/2022 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID, Digital Insurance Card

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/CAR/CARIN+IG+for+Digital+Membership+ID

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

7c. Co-Sponsor Approval Date

Apr 06, 2021

7d. US Realm Approval Date

Apr 06, 2021

7f. FMG Approval Date

Apr 07, 2021

Version

14

Modifier

Mark Roberts

Modify Date

Apr 07, 2021 20:40

1a. Project Name

CARIN IG for Digital Insurance Card

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2b. Co-Sponsor WG

Financial Management

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballot

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will request approval from the US Realm Steering Committee, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
1/2022 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID, Digital Insurance Card

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/CAR/CARIN+IG+for+Digital+Membership+ID

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

7c. Co-Sponsor Approval Date

Apr 06, 2021

7d. US Realm Approval Date

Apr 06, 2021

7f. FMG Approval Date

Apr 07, 2021

Version

13

Modifier

Mark Roberts

Modify Date

Apr 06, 2021 17:37

1a. Project Name

CARIN IG for Digital Insurance Card

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2b. Co-Sponsor WG

Financial Management

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballot

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will request approval from the US Realm Steering Committee, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
1/2022 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID, Digital Insurance Card

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/CAR/CARIN+IG+for+Digital+Membership+ID

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

7c. Co-Sponsor Approval Date

Apr 06, 2021

7d. US Realm Approval Date

Apr 06, 2021

Version

12

Modifier

Mark Roberts

Modify Date

Apr 06, 2021 17:32

1a. Project Name

CARIN IG for Digital Insurance Card

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2b. Co-Sponsor WG

Financial Management

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballot

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will request approval from the US Realm Steering Committee, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
1/2022 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID, Digital Insurance Card

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/CAR/CARIN+IG+for+Digital+Membership+ID

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

7c. Co-Sponsor Approval Date

Apr 06, 2021

Version

11

Modifier

Mark Roberts

Modify Date

Apr 06, 2021 17:25

1a. Project Name

CARIN IG for Digital Insurance Card

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2b. Co-Sponsor WG

Financial Management

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballot

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will request approval from the US Realm Steering Committee, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
1/2022 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/CAR/CARIN+IG+for+Digital+Membership+ID

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

7c. Co-Sponsor Approval Date

Apr 06, 2021

Version

10

Modifier

Mark Roberts

Modify Date

Apr 06, 2021 17:05

1a. Project Name

CARIN IG for Digital Membership ID

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2b. Co-Sponsor WG

Financial Management

2c. Co-Sponsor Level of Involvement

Request formal content review prior to ballot

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will request approval from the US Realm Steering Committee, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
1/2022 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/CAR/CARIN+IG+for+Digital+Membership+ID

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

7c. Co-Sponsor Approval Date

Apr 06, 2021

Version

9

Modifier

Mark Roberts

Modify Date

Apr 06, 2021 15:30

1a. Project Name

CARIN IG for Digital Membership ID

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will request approval from the US Realm Steering Committee, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
1/2022 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/CAR/CARIN+IG+for+Digital+Membership+ID

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

Version

8

Modifier

Mark Roberts

Modify Date

Mar 30, 2021 22:23

1a. Project Name

CARIN IG for Digital Membership ID

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

This FHIR implementation guide will use the US Core profiles. If this FHIR implementation guide is unable to use a US Core profile, we will request approval from the US Realm Steering Committee, and provide the US Realm Steering Committee an approved rationale for deviation in the implementation guide where applicable

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
9/2021 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://confluence.hl7.org/display/CAR/CARIN+IG+for+Digital+Membership+ID

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

STU to Normative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

Version

7

Modifier

Dave Hamill

Modify Date

Mar 30, 2021 21:01

1a. Project Name

CARIN IG for Digital Membership ID

1b. Project ID

1697

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
9/2021 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://build.fhir.org/

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

Comment (aka Comment-Only), Informative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

Version

6

Modifier

Mark Roberts

Modify Date

Mar 30, 2021 19:32

1a. Project Name

CARIN IG for Digital Membership ID

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
9/2021 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID

3h. Project Dependencies

None.

3i. HL7-Managed Project Document Repository URL:

https://build.fhir.org/

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

Comment (aka Comment-Only), Informative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

7b. Sponsoring WG Approval Date

Mar 30, 2021

Version

5

Modifier

Mark Roberts

Modify Date

Mar 16, 2021 19:49

1a. Project Name

CARIN IG for Digital Membership ID

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows

The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
9/2021 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID

3h. Project Dependencies

None.

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

Comment (aka Comment-Only), Informative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

Version

4

Modifier

Mark Roberts

Modify Date

Mar 16, 2021 19:22

1a. Project Name

CARIN IG for Digital Membership ID

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows


The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot
9/2021 - Publish
2023 Re-Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID

3h. Project Dependencies

None.

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

Comment (aka Comment-Only), Informative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

Version

3

Modifier

Mark Roberts

Modify Date

Mar 16, 2021 19:21

1a. Project Name

CARIN IG for Digital Membership ID

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows


The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

3b. Project Need

We believe there are app developers who are interested in developing a digital rendering of the physical insurance card mapped via FHIR.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - STU Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID

3h. Project Dependencies

None.

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

Comment (aka Comment-Only), Informative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

Version

2

Modifier

Mark Roberts

Modify Date

Feb 23, 2021 22:08

1a. Project Name

CARIN IG for Digital Membership ID

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows


The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

3b. Project Need

A health plan member has a physical insurance card, which contains demographic and plan information for coverage and benefits. This IG would develop a digital rendering of the physical insurance card mapped via FHIR. Applications could then display a rendering of the physical card via an app, which could be used as an alternative to the physical insurance card as proof of insurance.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID

3h. Project Dependencies

None.

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

Comment (aka Comment-Only), Informative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR

Version

1

Modifier

Mark Roberts

Modify Date

Feb 23, 2021 15:16

1a. Project Name

PSS for CARIN IG for Digital Membership ID

1b. Project ID

1643

1c. Is Your Project an Investigative Project (aka PSS-Lite)?

No

1d. Is your Project Artifact now proceeding to Normative directly or after being either Informative or STU?

No

2a. Primary/Sponsor WG

Pharmacy

2d. Project Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2g. Publishing Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2h. Vocabulary Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2k. Conformance Facilitator

Mark Roberts, Adam Culbertson, Cille Kissel

2m. Implementers

Humana, Cambia Health

3a. Project Scope

This project is intended to develop artifacts (FHIR implementation guides, code mappings, reference implementations, etc) to retrieve proof of insurance coverage information via FHIR when requested or shared by a Patient in order to create an electronic rendering of the insurance membership card within a digital application.

The information returned must meet the following requirements:
- Maintains parity with other FHIR resource that utilize similar data (Coverage, Patient, InsurancePlan, etc)
- Consistent with regulatory requirements for Patient Access, etc
- May be accessed in a synchronous workflow
- Meets practical business needs of providers/vendors that use this data in their workflows


The existing Coverage FHIR resource enables some of the insurance coverage information relevant to the member to be exchanged, but there are gaps which prevent the possibility of displaying a full digital rendering of the insurance card. The implementation guide for this project will include instructions, reference mappings, and sample implementations to enable insurers to express additional information such as Group ID, Network Name, Plan Logo, RxBIN, etc. The IG may incorporate elements from the WEDI Health ID IG where appropriate.

3b. Project Need

A health plan member has a physical insurance card, which contains demographic and plan information for coverage and benefits. This IG would develop a digital rendering of the physical insurance card mapped via FHIR. Applications could then display a rendering of the physical card via an app, which could be used as an alternative to the physical insurance card as proof of insurance.

3c. Security Risk

No

3e. Objectives/Deliverables and Target Dates

5/2021 - Draft implementation guide published
5/2021 - Connectathon
6/2021 - Development and Connectathon outcomes documented and presented to PIE Work Group
7/2021 - Ballot material approved by PIE Work Group
9/2021 - Ballot

3f. Common Names / Keywords / Aliases:

CARIN, Digital Membership ID

3h. Project Dependencies

None.

3j. Backwards Compatibility

N/A

3l. Using Current V3 Data Types?

N/A

3m. External Vocabularies

N/A

3o. Earliest prior release and/or version to which the compatibility applies

None.

4a. Products

Electronic Health Record (EHR) Functional Profile, FHIR Extensions, FHIR Implementation Guide, FHIR Resources, Guidance (e.g. Companion Guide, Cookbook, etc)

4b. For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?

R4

5a. Project Intent

Supplement to a current standard

5b. Project Ballot Type

Comment (aka Comment-Only), Informative

5d. Joint Copyright

No

6a. External Project Collaboration

CARIN Alliance

6b. Content Already Developed

10%

6c. Content externally developed?

Yes

6d. List Developers of Externally Developed Content

Adam Culbertson and Cille Kissel

6e. Is this a hosted (externally funded) project?

Yes

6f. Stakeholders

Payors, Other

6f. Other Stakeholders

Patients, Providers, Insurance companies, App developers

6g. Vendors

EHR, PHR, Equipment, Health Care IT

6h. Providers

Healthcare Institutions (hospitals, long term care, home care, mental health)

6i. Realm

U.S. Realm Specific

7a. Management Group(s) to Review PSS

FHIR