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Question

Where is the payer perspective represented in mCODE? 

Answer

mCODE 1.0 does not address payer-centric use cases involving the exchange of claims, coverage, insurance, or other related FHIR administrative data handled in financial management. 

There are some CodeX use cases which are considering payer data such as prior authorization use in oncology pathways, which are building upon mCODE. 

Contact the CodeX team for further information on possible development of new use cases to build upon the mCODE core model.


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