Payer Coverage Decision Exchange (PCDE)

Objective:

Support the portability of coverage by exchanging information between payers to define decision making and supporting documentation with regard to treatment for chronic illnesses without the need to burden the provider and/or patient or risk a discontinuity of care.

Workflow (click on the image to enlarge it)

Benefits

Supports continuity of treatment when patients enroll with a new payer by enabling a transfer of “current active treatments” between the prior payer and the new payer

Reduces the need for providers and/or patients to resubmit supporting documentation to the new payer in order to continue patient treatment

Reduces interruption in care plan and medication adherence

Reduces waste and rework by all parties

Sponsoring Workgroup: Financial Management 

Payer Coverage Decision Exchange Implementation Guide:

• Balloted Version (Sept 2019)
• Continuous Integration Build

STU Ballot Reconciliation:

• JIRA Dashboard - DaVinci PCDE STU1 Balloting Dashboard

Reference Implementation:

• pcde-ri

Test Scripts: Touchstone_DaVinciPCDE_Scripts

Zulip Channel: https://chat.fhir.org/#narrow/stream/179207-connectathon-mgmt/topic/PCDE.20Track

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Project Milestones

PCDE Team:

Historical Milestones Met: