Da Vinci 3-4 Coverage Requirement Discovery (CRD) and Medication Reconciliation (MRP) Profile

This profile contains a set of routes that implement two major processes:

1. Coverage Requirements Discovery: Before prescribing a treatment, the Provider makes a request to the Payer to get information on specific documentation requirements, on the rules for determining the need for the specific treatment or service, and on the requirements for Prior Authorization (PA) or other approvals, and specific guidance, if any. In this scenario, the Provider and the Payer exchange data using CDS hooks, and the Provider receives CDS cards with the information on the treatment cost and a list of medical conditions that require this kind of treatment.
2. Medication Reconciliation: After prescribing a treatment, the Provider notifies the Payer of the treatment and medication that has been prescribed for the patient.
   

Coverage Requirements Discovery Process

External Request Processing Route

The route receives a request that carries a CDS hook. If the incoming request has an order-select CDS hook, or order-sign CDS hook, the route extracts the medication code from the hook and makes a GET request to an external Coverage Requirement Discovery (CRD) service (emulated by the Da Vinci 3 CRD emulation other codes route) and passes the medication code as a query parameter. The CRD service returns a response with information on the treatment cost and retrieves a list of medical conditions that require this kind of treatment. Based on the response from CRD, the route generates CDS cards with the requested information, and the route returns the cards to the Provider.

3 CRD emulation code C8928

This subroute emulates the code C8928 processing. The subroute extracts patient data from the FHIR Server based on a request, checks to see if the patient's age is less or greater than 60 years for the service or device to be provided, and then returns a JSON-formatted response that contains the service description, costs, and other requirements to the parent route.

3 CRD emulation other codes

This route is an example of a Coverage Requirements Discovery (CRD) web service. The route creates a response messages for the E0433 and other codes based on the Velocity templates, triggers a subroute to process the C8928 code to also create a response message, and then the route returns a JSON-formatted response that contains the service/ device description, costs, and other requirements.

Click to see a sample CRD response

{

"costs": [

{

"amount": "$50.00",

"timing": "monthly",

"cost": "Oxygen Tank"

},

{

"amount": "$100.00",

"timing": "monthly",

"cost": "Services"

}

],

"url": "https:\/\/testHost/OxygenTherapyOrder.pdf",

"description": "Portable liquid oxygen system, rental: home liquefier used to fill portable liquid oxygen containers, includes portable containers, regulator, flowmeter, humidifier, cannula or mask and tubing, with or without supply reservoir and contents gauge",

"requirements": [

"Diagnoses requiring supplemental oxygen",

"Arterial oxygen partial pressure (PO2) level is below the normal level of 55 mm Hg",

"O2 saturation level is below the normal level of 80%",

"Documentation alternative therapies were tried and not completely effective",

"Patient is mobile if portable O2 supplies are ordered",

"Patient is exhibiting symptoms associated with oxygen deprivation \u2013 impairment of cognitive processes and restlessness"

],

"crd": "E0433"

}

Medication Reconciliation Process

Medication Reconciliation Data Requirements Route

The route represents a service that requests the Payer to return a list of previously prescribed medication.

Da Vinci 4 Reconciliation Emulation Route

The route either returns a list of previously prescribed medication retrieved from the Payer's FHIR server or submits a list of newly prescribed medication.

Medication Reconciliation Submit Data Route

This route receives a POST request with information on the medication prescribed by the Provider for the patient and submits the data to the Payer's FHIR Server.