35. Has the Work Group posted its consideration of all comments received in its reconciliation document on the ballot desktop?
36. Substantive Changes Since Last Ballot?
37. Product Brief Reviewed By
38. Date Product Brief Reviewed
Dec 01, 2020
39. Has the Product Brief changed?
Clinical and Administrative Domains
43. Please Describe the Topic
44. Product Type
45. Parent standard
46. Parent Standard Status
47. Update/replace standard
48. Common name/search keyword
Provides a mechanism for healthcare providers to discover guidelines, pre-authorization requirements and other expectations from payor organizations related to a proposed medication, procedure or other service associated with a patient's insurance coverage. Supports both patient-specific and patient-independent information retrieval.
These are categories of potential users, implementers, or other interested parties such as those that are indicated on the Project Scope Statement under “Stakeholders/Vendors/Providers”. Select those that are applicable, or suggest others:
Emergency ServicesHealthcare Institutions (hospitals, long term care, home care, mental health)Other (specify in text box below)
Ensures providers are aware of payer-specific requirements at the time of decision-making. Reduces provider burden by simplifying prior authorization processes. Allows awareness of coverage to be considered as part of planning patient care.
54. Implementations/Case Studies
Reference implementation created by MITRE.
Test implementation by Mettle Solutions
55. Development Background
This specification was created as part of the Da Vinci project with significant participation from the U.S. Payer community as well as several EHR software vendors.