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The goal of this use case is to reduce provider burden and simplify process by establishing electronic versions of administrative and clinical requirements that can become part of the providers workflow.  An exemplar for this use case is to follow the approach taken to incorporate formulary requirements interactively into the medication selection process. Proposal includes the ability to inject payer coverage criteria into provider workflows akin to clinical decision support (CDS Hooks), to expose rules prospectively while providers are making care decisions.

Sponsoring Workgroup: Clinical Decision Support

Project Milestones




Profile and Operation DevelopmentMarch

Test Case Development

Ballot for CommentMay
Reference Implementation
STU BallotSeptember

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May Ballot Milestones


May Ballot Deadlines (2019)

PSS Sponsor Approval

January 27

Notice of Intent to Ballot

February 17

Initial IG Content

March 3

Final IG Content

March 24

Ballot Voting Starts

March 29

Ballot Voting Ends

April 29

Ballot Reconciliation Starts

May 5

Ballot Reconciliation CompleteJuly 21

September Ballot Milestones (STU)


September Ballot Deadlines (2019)

Project Scope Statement (PSS)April 7
Notice of Intent to Ballot (NIB)June 30
Ballot signup startsJuly 8
Initial contentJuly 14
Ballot QA period startsJuly 21
Final contentAugust 4
Ballot voting startsAugust 9
Ballot voting endsSeptember 9


RoleName OrganizationEmail 
Project LeadRobert (Bob) Dieterle Enable
Clinical Process SME Dr. Viet NguyenStratametrics 
Development Lead 

Larry Decelles
Program ManagerJocelyn KeeganPoint of Care
Project ManagerDana MarcelonisPoint of Care Partners

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  1. Location of Draft IG for Documentation Templates and Payer Rules -