Do not launch ANY of the links while your are in create or edit mode. There is a good chance all of your work will be gone.
Template Usage Information:
- Submit template change requests to PMO@HL7.org
- For Reaffirmations, please refer to the FAQ in Hl7 Project Scope Statement Instructions for a list of which sections and fields should be completed
Project Name and ID
Enter the name of the project here: Uniform Structure and Coding Elements for Prior Authorization
Complete this section for all “Direct to Normative” ballot projects and when a project proceeds from “Informative to Normative” or “STU to Normative”.
Forward PSS to the TSC (via tscpm@HL7.org); this triggers American National Standards Institute (ANSI) Project Initiation Notification (PINS) submission.
TSC Notification: Informative/STU to Normative
Date: Submission date
- or - Direct to Normative (no STU) (includes reaffirmations)
Identify ISO, IEC or ISO/IEC standard to be adopted in text box below
Enter info here if an ISO, IEC, or ISO/IEC Standard is to be adopted as an American National Standard; Enter the designation of the standard(s) to be adopted:
Includes text from ISO, IEC or ISO/IEC standard: Check here if this standard includes excerpted text from one or more ISO, IEC or ISO/IEC standards, but is not an identical or modified adoption.
No - X
Select the unit of measure used in the standard; if no measurements are in the standard, select N/A
Investigative Project (aka PSS-Lite)
Check this box when the project is investigative or exploratory in nature, which allows limited project scope definition. Sections 1-Project Name, 2-Sponsoring Group(s)/Project Team, 3a-Project Scope, 3b-Project Need, 3e-Project Objectives/Deliverables/Target Dates, 3i-Project Document Repository, 6b-[Realm, if known], and 6d-[applicable Approval Dates] are required for Investigative Project. Investigative Project specific instructions are highlighted in yellow. An investigative project must advance in two WGM cycles, requiring a full scope statement. Otherwise the project will be closed.
2. Sponsoring Group(s) / Project Team
2.a. Primary Sponsor/Work Group
Primary Sponsor/Work Group
HL7 Financial Management
2.b. Co-sponsor Work Group(s)
Co-sponsor Work Group(s):(Enter co-sponsor approval dates in Section 6.d Project Approval Dates)
|Indicate the level of involvement that the co-sponsor will have for this project:|
|Request formal content review prior to ballot|
|Request periodic project updates. Specify period|
|Other Involvement. Specify details here:|
2.c. Project Team
All names should have confirmed their role in the project prior to submission to the TSC.
Project facilitator (1Mandatory)
Other interested parties and their roles
Multi-disciplinary project team (recommended)
Enter a name here (or ask Vocab for a name):
Domain expert rep
Business requirement analyst
Conformance facilitator (for IG projects)
Other facilitators (SOA, etc)
Implementers (2 Mandatory for STU projects)
FHIR Project Note: The implementer requirement will be handled by the “balloting” project. Therefore work groups do not fill out the above section. However, feel free to list implementers specific to your work group’s resources if you know of any.
3. Project Definition
3.a. Project Scope
Describe the project; include what is expected to be accomplished/delivered along with specified features and functions. Include whether the deliverable(s) are universal, realm specific or applicable to various realms. Be sure to spell out all acronyms as these are carried forward to the NIB (Notice of Intent to Ballot) for ballot announcements..
As a supplement to the Da Vinci Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS) FHIR implementation guides, this group will:
3.b. Project Need
This information is required by ANSI for all ballots. Briefly explain the reason behind the need for this project. This may be related to legislative requirements, industry need, or similar justifications.
The United States has one of the world’s most complex healthcare systems, with different organizations providing different types of care across geographic and clinical lines as well as with hundreds of separate payer organizations often with differing documentation requirements to justify coverage/payment. Providers can often feel overwhelmed by the differing and hard to access documentation requirements of the various health plans.
There are a number of benefits that could be recognized if required documentation elements were more clearly defined across payers. If required data elements are more clearly defined, there may be reduced provider burden by:
3.c. Security Risks
Will this project produce executable(s), for example, schemas, transforms, style sheets, executable program, etc. If so the project must review and document security risks. Refer to the Cookbook for Security Considerations for additional guidance, including sample spreadsheets that may be used to conduct the security risk assessment.
3.d. External Drivers
Describe any external schedules or calendars which may not be known outside of the project team that are driving target dates for this project..
3.e. Project Objectives / Deliverables / Target Dates
Within each row, enter the explicit work product(s) / objective(s). Indicate their target date at the right in WGM/Ballot Cycle format. Include the project end date as the last objective (for standards projects, the end date will be the projected ANSI approval date).
Target Date(in WGM or ballot cycle format, e.g.
‘2017 Sept WGM’ or
‘2017 Jan Ballot’)
Enter objective/deliverable here.
All planned ballots and their target dates should be included
Enter Target Date
Submit for first Informative Ballot
2022 Jan Ballot
2022 May WGM
Submit for 2nd Informative Ballot
|2022 September Ballot|
|2023 January WGM|
|2024 January WGM|
Submit for Normative Ballot
|2024 May WGM|
Receive ANSI Approval
Project End Date (all objectives have been met)
3.f. Common Names / Keywords / Aliases
What common name does your group use to refer to the product(s) produced? What alternative names, aliases and keywords does your group use to refer to the product(s) that will be produced? Some examples: C-CDA, LRI, eDOS.
Uniform Structure and Coding Elements for Prior Authorization, Payer Uniformity, Superset of Payer Documentation Requirements, Common Elements
If your project creates a Post-Release 1 version; indicate the name of the prior product and if it is supplanting, replacing or coexisting with a previous release:
3.h. Project Dependencies
Enter any dependencies or the name & Project Insight ID of project(s) that this project is dependent upon to achieve its objectives:
1493 – Documentation Templates and Rules (Da Vinci)
1490 – Prior Authorization Support (Da Vinci)
1428 – FHIR Implementation Guide for Coverage Requirements Discovery (Da Vinci)
Projects and their Project Insight IDs can be found via http://www.hl7.org/special/Committees/projman/searchableProjectIndex.cfm?ref=common
3.i. HL7-Managed Project Document Repository Location
A template to create a Project Page on the HL7 Wiki is available at: http://wiki.hl7.org/index.php?title=Template:Project_Page.
|Enter the SPECIFIC URL of the HL7-MANAGED SITE where supporting project documents, deliverables, ballot reconciliation work and other project information will be kept.|
3.j. Backwards Compatibility
Are the items being produced by this project backward compatible?
If you check 'Yes' please indicate the earliest prior release and/or version to which the compatibility applies:
For V3, are you using the current data types?
(Refer to TSC position statement on new projects using R2B for more information on the current V3 data types)
If you check no, please explain the reason:
If desired, enter additional information regarding Backwards Compatibility.
3.k. External Vocabularies
Will this project include/reference external vocabularies?
If Yes, please enter the vocabularies: LOINC, SNOMED CT, HCPCS/CPT, RxNORM, ICD-10-CM
4. Products (check all that apply)
V2 Messages – Administrative
Clinical Information Modeling Initiative (CIMI)
V2 Messages - Clinical
Clinical Context Object Workgroup (CCOW)
V2 Messages - Departmental
Domain Analysis Model (DAM)
V2 Messages – Infrastructure
Electronic Health Record (EHR) Functional Profile
V3 Domain Information Model (DIM / DMIM)
FHIR Extensions (recommendations)
V3 Documents – Administrative (e.g. SPL)
FHIR Implementation Guide (enter FHIR product version below)
V3 Documents – Clinical (e.g. CDA)
FHIR Profiles (enter FHIR product version below)(recommendations)
V3 Documents - Knowledge
V3 Foundation – RIM
Guidance (e.g. Companion Guide, Cookbook, etc)
V3 Foundation – Vocab Domains & Value Sets
V3 Messages - Administrative
V3 Messages - Clinical
New Product Definition (please define below)
V3 Messages - Departmental
New Product Family (please define below)
V3 Messages - Infrastructure
Non Product Project - (Educ. Marketing, Elec. Services, etc.)
V3 Rules - GELLO
V3 Services – Java Services (ITS Work Group)
Creating/Using a tool not listed in the HL7 Tool Inventory
V3 Services – Web Services (SOA)
If you checked New Product Definition or New Product Family, please define below:
For FHIR IGs and FHIR Profiles, what product version(s) will the profiles apply to?
5. Project Intent (check all that apply)
Create new standard
Supplement to a current standard
Revise current standard (see text box below)
Implementation Guide (IG) will be created/modified
Reaffirmation of a standard
Project is adopting/endorsing an externally developed IG:
New/Modified HL7 Policy/Procedure/Process
Specify external organization in Sec. 6 below;
Externally developed IG is to be (select one):
White Paper (select one):
Adopted - OR -
Balloted Informative OR
Non-balloted WG White Paper
N/A (Project not directly related to an HL7 Standard)
If revising a current standard, indicate the following:
|- Name of the standard being revised:|
|- Date it was published (or request for publication, or ANSI designation date)|
|- Rationale for revision|
|- The relationship between the new standard and the current standard (is it designed to replace the current standard, a supplement to the current standard, etc.)|
5.a. Ballot Type (check all that apply)
Comment (aka Comment-Only)
Joint Ballot (with other SDOs)
N/A (project won’t go through ballot)
STU to Normative - OR -
Normative (no STU)
If necessary, add any additional ballot information here. If artifacts will be jointly balloted with other SDOs, list the other groups.
|The intent is to create an informative guide to recommend enhancements to current FHIR artifacts (including code systems and value sets) to support concise definition of payer documentation requirements.|
5.b. Joint Copyright
Check this box if you will be pursuing a joint copyright. Note that when this box is checked, a Joint Copyright Letter of Agreement must be submitted to the TSC in order for the PSS to receive TSC approval.
Joint Copyrighted Material will be produced?
6. Project Logistics
6.a. External Project Collaboration
Include SDOs or other external entities you are collaborating with, including government agencies as well as any industry outreach. Indicate the nature and status of the Memorandum of Understanding (MOU) if applicable.
For projects that have some of their content already developed:
How much content for this project is already developed?
Was the content externally developed ? :
Is this a hosted (externally funded) project? (not asking for amount just if funded)
- OR -
Check here if this standard balloted or was previously approved as realm specific standard
Enter “U.S.” or name of HL7 affiliate(s) here. Provide explanation/justification of realm selection. For projects producing deliverables applicable to multiple realms, document those details here.
For Investigative projects, indicate if the project is planned to be Realm Specific or Universal, if known. Work Groups are encouraged designating project a Universal project initially, and discover which Realms can contribute to the work effort during the discovery phase of the project. Note: This status is subject to change during the investigative process.
6.c. Stakeholders / Vendors / Providers
This section must be completed for projects containing items expected to be ANSI approved, as it is an ANSI requirement for all ballots
Clinical and Public Health Laboratories
Clinical and Public Health Laboratories
Quality Reporting Agencies
Local and State Departments of Health
Health Care IT
Medical Imaging Service
Standards Development Organizations (SDOs)
Clinical Decision Support Systems
Healthcare Institutions (hospitals, long term care, home care, mental health)
Other (specify in text box below)
Other (specify in text box below)
Other (specify below)
Other: Indicate other stakeholders, vendors or providers not listed above.
6.d. Project Approval Dates
Click here to go to HL7 Project Scope Statement Instructions#Appendix A for more information regarding this section.
Approvals are by simple majority vote of the approving body
Sponsoring Work Group Approval Date:
WG Approval Date
Approved name change
Administrative review – in parallel with Work Group Approval
Co-Sponsor Group Approval Date
Family Management Group Approval Date(s)
CIMI Projects: CIMI Management Group
CIMI MG Approval Date
CDA Projects: CDA Management Group
CDA MG Approval Date
FHIR Projects: FHIR Management Group
FMG Approval Date
V2/Publishing Projects: V2 Management Group
V2 MG Approval Date
US Realm Projects: US Realm Steering Committee Approval
USRSC Approval Date
Affiliate Specific Projects: Affiliate Approval Date
Affiliate Approval Date
Submit PSS to Steering Division after all of the above approvals are received
Steering Division (of Primary Sponsor WG) Approval Date:
SD Approval Date CCYY-MM-DD
ARB and Steering Division approval may be in parallel
Architectural Review Board Approval Date:
(required for externally developed content)
ARB Approval Date
If applicable, TSC has received a Joint Copyright/Distribution Agreement (containing the verbiage outlined within the SOU),
Technical Steering Committee Approval Date:
TSC Approval Date