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Payer Survey [AN1]

Welcome to the Payer Survey.


Thank you for participating in this important survey that will help us determine the feasibility of one approach to improving compliance with documentation requirements and reducing the burden associated with ordering DME. For more information on this effort, being developed by the Health Level Seven (HL7) Da Vinci work group, please click here or go to: .


This survey should take approximately 10 minutes to complete. Please be reassured that all survey findings will be provided only in aggregate fashion, and no individual responses will be presented. The Da Vinci work group will use these survey results to assess the current state of functionality required for electronic data exchange of documentation requirements. Please click ‘Next’ to begin.

[provide a link to additional information if needed]

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  1. What types of plans do you offer? Select all that apply.
  • Medicare Advantage
  • Medicaid
  • Medicaid Managed Care
  • Children’s Health Insurance Program
  • Commercial HMO/PPO/Other
  • Staff Model HMO
  1. Please indicate whether your plan has any of the following for covered services or devices? Select all that apply
  • Specific documentation requirements
  • Rules for determining medical necessity for specific services or devices
  • Requirement for Prior Authorization (PA) or other approvals
  • Specific guidance
  1. Do you or your contracted pharmacy benefit manager (PBM) support the electronic prior authorization for medication NCPDP standard [1] ?

If response is:

Yes- go to 5

No- go to 4

  1. Why not? Free text
  2. Do you have an online provider directory?
  3. Do you support electronic medical necessity checking? [MKM2] If no skip to question 8
  4. How do you provide the service? [MKM3] Select all that apply
  • Use third party vendors standards
  • Provide data files to third party vendor (e.g. 3M, Passport)
  • Make data files available for download to anyone
  • Online app
  • API
  1. Are your coverage requirements posted online for public access? [MKM4] If no, skip to question 12
  2. Are they searchable by service/device/diagnosis?
  3. Do your coverage requirements include details of information that providers are required to document in the medical record (i.e., documentation requirements ?
  4. Do you provide templates to assist providers with completion of required documentation?
  5. Are you participating in the HL7 Da Vinci Project ?
  6. Do you support CDS Hooks ? Yes/No/I don’t know [MKM5]
  7. Do you provide logic for your online coverage requirements written in clinical quality language (CQL [MKM6] )? Yes/No/I don’t know
  8. Have you created Application Programming interfaces (APIs) for either internal or external use? Yes/No/I don’t know
  9. Do you support Fast Healthcare Interoperability Resources (FHIR)? Yes/No/I don’t know

If no skip to question 19

  1. Do you support any SMART on FHIR apps ? If no, skip to question 19
  2. What functionality do these apps provide (e.g. asthma treatment plans, medication adherence tools)?
  3. How do you request additional medical record documentation from providers? Select all that apply
  • By phone
  • By fax
  • By secure email
  • By mail
  • ASC X12N 277 Health Care Claim Request for Additional Information
  • ASC X12N 278 Health Care Service Review – Request for Review and Response
  • Other electronic method Free text
  1. Do you support electronic submission of documentation (esMD)? [MKM7]
  2. Do you support either of these routing/enveloping standards? Select all that apply
  • ASC X12N 275 Additional Information to Support a Health Care Claim or Encounter
  • ASC X12N 275 Additional Information to Support a Health Care Services Review
  1. Select the ways you support receiving content electronically. Select all that apply
  • Direct interface(s)
  • Secure email
  • HL7 CDA® R2 Attachment Implementation Guide
  • HL7 C-CDA R2 – Consolidated Clinical Documentation Architecture Release 2
  • Third party interfaces (e.g. Fast Attach)
  • Other Free text [MKM8]
  1. Do you have direct interfaces with DME suppliers to send and/or receive medical records/clinical data?
  2. Do you have direct interfaces with clinicians to send and/or receive medical records/clinical data?
  3. Do you have direct interfaces with Electronic Health record (EHR) vendors to send and/or receive medical records/clinical data? If no, end survey [MKM9]
  4. Please select the vendors you are interfaced with. Select all that apply

( Note these are the top EHR vendors in ambulatory and hospital reporting per ONC data)

EHR Vendor [MKM10]

Allscripts Professional EHR

Allscripts TouchWorks EHR

Amazing Charts


Centricity EMR


ChartLogic EHR

Compulink Business Systems




e-MDs Solution Series



FairWarning Technologies


Iatric Systems

Integrated Practice Solutions







Midas+ Solutions

Modernizing Medicine

NextGen Healthcare

Orion Health

Practice Fusion

SCC Soft Computer


Sunquest Information Systems

The Staywell Company, LLC


Other: Free text

After completing this question display “Thank you for participating”


[1] National Council for Prescription Drug Programs.

[AN1] Follow up on participant list for payer respondents.

[MKM2] I have no idea what this means. Should we provide context and a definition?

[MKM3] What service? Electronic medical necessity checking?

[MKM4] If yes, you may want to ask the format, pdf, word, etc.

[MKM5] Do you currently support CDS Hooks?


If not, do you have plans to?



[MKM6] Maybe a base question is “are you familiar with CQL”?


Then do you provide logic for….



[MKM7] Is this the CMS program or overall?

May need to clarify.



Add upload via organizational portals.


[MKM9] Again, there are specific portals payers have that allow the clinicians to upload…


How about all the homegrown systems that are our there?