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The project team plans to work with existing FHIR artifacts where possible. If changes are necessary, the project team will work with the responsible Work Group to review and implement (via tracker items or new PSS)any necessary enhancements to base FHIR resources, extensions, and/or profiles.

Updated on 5/20/2020 to limit scope to R4 only.

3.b. Project Need

Providers need to have access to executable payer requirements to ensure that documentation supports the medical necessity and appropriateness of a covered service, gather information for authorizations, perfect orders and referrals for patient treatment. The need is for standard representation of payer requirements that can be executed by payer CDS or by rules that can be executed in the context of a SMART of FHIR application. The solution must support the ability to evaluate the current patient information, request missing information, suggest addition evaluations that need to be performed/documented, and incorporate the answers in the clinical record.


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)