DA-VINCI-PROJECT
Da Vinci Project HL7 FHIR Accelerator payer-provider 2018.
Définition
Da Vinci Project key IGs : (1) Coverage Requirements Discovery (CRD) : EHR queries payer at point of order for coverage requirements applicable to ordered service (e.g., prior auth required, network status, alternative cheaper service available). (2) Documentation Templates and Rules (DTR) : payer provides clinical documentation requirements + clinical decision support hooks to assist provider gathering required clinical info for prior auth. (3) Prior Authorization Support (PAS) : standardized FHIR-based prior authorization request + response workflow replacing X12 278 (X12 278 still required HIPAA but FHIR PAS provides clinical attachments + workflow improvements). (4) Member Attribution List : ACO + value-based care attribution data exchange payer to provider. (5) Plan-Net : provider directory FHIR exchange. (6) Da Vinci Payer Data Exchange (PDex) : payer-to-payer + patient access clinical data via FHIR. (7) Da Vinci PDex Plan-Net : provider directory FHIR for payers. (8) Da Vinci CDex (Clinical Data Exchange) : payer requests specific clinical data from providers (e.g., for utilization management or claims adjudication). (9) Da Vinci HEDIS + Risk Adjustment quality measure reporting. CMS Interoperability + Prior Authorization Rule 2024 mandates payers implement Da Vinci PAS + CRD + DTR FHIR APIs by January 2027 for prior auth API + by January 2026 for Patient Access + Provider Access + Payer-to-Payer APIs.
Origine
Da Vinci Project launched mai 2018 ; HL7 FHIR Accelerator ; ~100+ member organizations 2024 ; ~15+ IGs published.
Exemple en contexte
Provider orders MRI for patient ; EHR invokes CRD hook to payer FHIR endpoint, payer returns CRD response indicating prior auth required + relevant clinical criteria ; EHR invokes DTR launches SMART app with payer-provided template gathering required clinical info from chart, provider completes ; EHR submits PAS prior auth request with completed clinical documentation, payer FHIR PAS endpoint returns approval/denial decision in real-time vs traditional X12 278 days-long batch process.
Termes liés
- Argonaut Project — sister FHIR Accelerator clinical.
- SMART on FHIR — underlying authorization.