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HITSP Communicate Referral Authorization Capability Public Review

HITSP Communicate Referral Authorization Capability Public Review. Administration and Finance Domain Technical Committee October 1, 2009. HITSP Communicate Referral Authorization Capability Requirements and Design Public Comment. Introduction Schedule Review of Capabilities

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HITSP Communicate Referral Authorization Capability Public Review

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  1. HITSP Communicate Referral Authorization Capability Public Review Administration and Finance Domain Technical Committee October 1, 2009 HITSP Capabilities Public Review Webinar

  2. HITSP Communicate Referral Authorization Capability Requirements and Design Public Comment • Introduction • Schedule • Review of Capabilities • Technical Approach • Public Comment HITSP Capabilities Public Review Webinar

  3. HITSP Communicate Referral Authorization Capability Requirements and Design Public Comment • Introduction • Schedule • Review of Capabilities • Technical Approach • Public Comment HITSP Capabilities Public Review Webinar

  4. Introduction • The purpose of this Webinar is to provide a high-level overview of a HITSP proposed solution for exchanging prior-authorization information between a Pay Benefits Manager and a Provider or Pharmacy • Today we will be discussing the requirements section of the document. The capability and all associated HITSP constructs will be released for the traditional 4 week public comment period in early November HITSP Capabilities Public Review Webinar

  5. Introduction – Co-Chairs and Staff HITSP Capabilities Public Review Webinar

  6. Healthcare Information Technology Standards Program (HITSP) • Providing specifications that integrate diverse standards to meet clinical and business needs for sharing information: • Develop specifications that address broad stakeholder perspectives • Support testing and validation of specifications • Catalyze efforts of standards organizations to realize changes to address gaps and overlaps • Enabling Interoperability between healthcare stakeholders Specifying Standards needed to enhance care quality and contain costs HITSP Capabilities Public Review Webinar

  7. Constructs (single purposeor reusable) Base or Composite Standards HITSP Interoperability Specifications Type 1: Base or Composite Standards A complete IS set provides a framework that defines • A hierarchy of constructs • The role of each construct • The relationship of one construct to another in the context of specific business and/or clinical requirements Interoperability Specification (construct) Interoperability Specification (Complete Set) HITSP Capabilities Public Review Webinar

  8. Capabilities and Service Collaborations Keys to Simpler Definition and Implementation of HITSP Specifications HITSP Capabilities Public Review Webinar

  9. Service Collaboration (SC) • Defines a standards-based secure infrastructure needed for interoperable information exchanges • Includes a secure transport mechanism with topology and other options • Uses HITSP Constructs to specify the secure infrastructure • Does not specify the content of the information exchange but may include information to support the exchange (e.g., authorization information) HITSP Capabilities Public Review Webinar

  10. Patient consent Management • Delivery notification • Email address/ • distribution list • Patient Identification • Topology • System-to-System • Portable Media • System-to-HIE • HIE-to-HIE Service Collaboration Standards-based Secure Infrastructure Needed for Interoperable Information Exchanges HITSP Capabilities Public Review Webinar

  11. Service Collaborations • SC108 - Access Control • SC109 - Security Audit • SC110 - Patient Identification Management • SC111 - Knowledge and Vocabulary • SC112 - Healthcare Document Management • SC113 - Query for Existing Data • SC114 - Administrative Transport to Health Plan • SC115 - HL7 Messaging • SC116 - Emergency Message Distribution Element HITSP Capabilities Public Review Webinar

  12. HITSP Capability • Enables systems to address a business need for interoperable information exchange • Bridges between business, policy and implementation views: • Defines a set of information exchanges at a level relevant to policy and business decisions • Supports stakeholder requirements and business processes • Defines information content and secure infrastructure • Specifies use of HITSP constructs sufficiently for implementation • Includes constraints and identifies specific network topologies HITSP Capabilities Public Review Webinar

  13. What is an example of a capability? I want to exchange a prescription with an Ambulatory or Long-Term Care (LTC) Organization • System Roles • Medication Order Prescriber • Medication Order Filler • Health Plan • Health Information Exchange (HIE) • Requirement: An organization wants to exchange a prescription with an ambulatory organization • The diagram on the right shows how Capability 117 was assembled to support this requirement CAP117 – Communicate Ambulatory and Long Term Care Prescription HITSP Capabilities Public Review Webinar

  14. Existing HITSP Capabilities – Clinical Operations HITSP Capabilities Public Review Webinar

  15. Existing HITSP Capabilities – Public Health and Emergency Response; Administration and Finance HITSP Capabilities Public Review Webinar

  16. Existing HITSP Capabilities - Security, Privacy, and Infrastructure HITSP Capabilities Public Review Webinar

  17. Capability • Delivery notification • Email address/ • distribution list • Patient consent Management • Patient Identification • Topology • System-to-System • Portable Media • System-to-HIE • HIE-to-HIE • Defining Content • Component Service Collaboration Service Collaboration Marrying Content Definition with Secure Infrastructure for a set of Interoperable information exchanges HITSP Capabilities Public Review Webinar

  18. HITSP Communicate Referral Authorization Capability Requirements and Design Public Comment • Introduction • Schedule • Review of Capabilities • Technical Approach • Public Comment HITSP Capabilities Public Review Webinar

  19. Schedule • Requirements for Prior-Authorization introduced to the Public via Webinar October 1st • Comment feedback on the Requirements for this work item closes October 8th • The process for submitting comments is included on slide 46 of this presentation • The Capability with all supporting constructs will be released for a 4 week Public Comment period in early November HITSP Capabilities Public Review Webinar

  20. HITSP Communicate Referral Authorization Capability Requirements and Design Public Comment • Introduction • Schedule • Review of Capabilities • Technical Approach • Public Comment HITSP Capabilities Public Review Webinar

  21. Definition of Capabilities • Capabilities provide the ability for two or more systems to address a business need for interoperable information exchange • The objective is to provide the bridge between the business, policy and implementation disciplines by: • Defining a set of information exchanges at a level relevant to policy and business decisions • Supporting stakeholder requirements and business processes by including information content, infrastructure, Security, Privacy • Specifying the use of HITSP constructs sufficiently for implementation • Including constraints and operating on specific network topologies (contexts) • Capabilities have topology and other options (e.g., point-to-point, portable media, system-to-HIE, HIE-to-HIE) HITSP Capabilities Public Review Webinar

  22. What is a capability? Requirements • Capabilities are specified using HITSP Constructs • As part of the HITSP Tiger Team effort addressing ARRA, Capabilities are meant to clearly state what types of data HITSP can and cannot “exchange” • During the ARRA Tiger Team effort, no new standards were selected, and no new constructs were specified to build capabilities Orchestration of HITSP Constructs and System Roles HITSP Constructs System Roles Capability HITSP Capabilities Public Review Webinar

  23. HITSP Communicate Referral Authorization Capability Requirements and Design Public Comment • Introduction • Schedule • Review of Capabilities • Technical Approach • Public Comment HITSP Capabilities Public Review Webinar

  24. Technical Approach of Capability 141 • High level review of the purpose of this capability • Review of the requirements that have been defined HITSP Capabilities Public Review Webinar

  25. Purpose of Capability 141 • Addresses interoperability requirements that support electronic inquiry and response for authorizing a health plan member to be referred for service by another provider or to receive a type of service or medication under the patient’s health insurance benefits. • The Capability supports: • Transmittal of a patient and insurance identification information • Identification of the type of service or medication requested for benefit coverage • Communication of authorization number from the Payer System • It provides clinicians and pharmacists with information about each patient’s medical insurance coverage and benefits. It may include information on referral or authorization permission HITSP Capabilities Public Review Webinar

  26. Why The Capability Was Developed • Capability 141 was developed to enable: • Consumers and Providers to request prior-authorization for medical related encounters and medications • Payors to respond to such requests • Payors to provide: • Non-patient specific guidelines for prior-authorization • Patient specific guidelines for prior-authorization HITSP Capabilities Public Review Webinar

  27. Capability 141 Information Exchanges HITSP Capabilities Public Review Webinar

  28. Service Collaborations Included in Capability 114 • Uses HITSP/Service Collaboration 114 • SC 114 contains the Security, Privacy, and Infrastructure functionality depicted in the table below • Also includes HITSP/T85 – Administrative Transport to Health Plan • T85 uses CAQH Phase II CORE #270 Connectivity Rule v2.0.0, which addresses the message envelope metadata and envelope standards, submitter authentication standards , and communications-level errors, and acknowledgements HITSP Capabilities Public Review Webinar

  29. Information Exchange Options *NOTE: As the gaps are evaluated email will be reconsidered HITSP Capabilities Public Review Webinar

  30. Capability 141 Requirements • Detailed definition of the requirements, recommended solutions and identified gaps in the solutions may be found in Section 6 of the document • The following slides provide a high-level overview of the requirements HITSP Capabilities Public Review Webinar

  31. Consumer Requirements HITSP Capabilities Public Review Webinar

  32. Consumer Requirements HITSP Capabilities Public Review Webinar

  33. Provider Requirements HITSP Capabilities Public Review Webinar

  34. Provider Requirements HITSP Capabilities Public Review Webinar

  35. Provider Requirements HITSP Capabilities Public Review Webinar

  36. Provider Requirements HITSP Capabilities Public Review Webinar

  37. Provider Requirements HITSP Capabilities Public Review Webinar

  38. Payor Requirements HITSP Capabilities Public Review Webinar

  39. Payor Requirements HITSP Capabilities Public Review Webinar

  40. Payor Requirements HITSP Capabilities Public Review Webinar

  41. Payor Requirements HITSP Capabilities Public Review Webinar

  42. Payor Requirements HITSP Capabilities Public Review Webinar

  43. Payor Requirements HITSP Capabilities Public Review Webinar

  44. Payor Requirements HITSP Capabilities Public Review Webinar

  45. HITSP Communicate Referral Authorization Capability Requirements and Design Public Comment • Introduction • Schedule • Review of Capabilities • Technical Approach • Public Comment HITSP Capabilities Public Review Webinar

  46. Comment Tracking System • HITSP.org link:http://www.hitsp.org/public_review.aspx Using the HITSP Comment Tracking System The HITSP Comment Tracking System allows registered authors to provide comments on documents that are undergoing public review or implementation testing. A unique user ID and password is required for each comment submitter Please note that the Comment Tracking System closes at 5 PM Pacific Daylight Time on the final day of public review, October 8th Current HITSP members:Submit comments by following the link above and entering your current user ID and password New Users: Contact Hzander@ansi.org for a user name and password to access the CTS Add CommentRegister a NEW comment in the tracking system View (My) CommentsView the status or disposition of a comment previously submitted Please contact Hannah Zander (HZander@ansi.org) with any questions or problems with entering comments HITSP Capabilities Public Review Webinar

  47. Questions and Comments • Comments regarding the Requirements outlined to meet the needs of Communicate Referral Authorization are welcome during this portion of the Webinar • Comments regarding the complete Capabilities documents can be addressed via Comment Tracking System (see previous slide for instructions) HITSP Capabilities Public Review Webinar

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