Request for data necessary from payers to support claims for services.

Request for data necessary from payers to support pre-authorization for services.

Request for data from payers to calculate differences in beneficiary-level risk factors that can affect quality outcomes or medical costs, regardless of the care provided.

Request for data used for aggregation, calculation and analysis, and ultimately reporting of quality measures.

Request for additional clinical information from referring provider to support performing the requested service.

Request for data from payers to support the non-medical social needs of individuals, especially the elderly, vulnerable or with special needs.

Request for data from payers for other authorization request not otherwise specified.

Request for data from payers to create a complete clinical record for each of their members to improve care coordination and provide optimum medical care.

Request for data used from payers or providers for general documentation.

Request for additional clinical information from referring provider to support orders.

Requests for patient health record information from payers to support their payer member records.

Request for signatures from payers or providers on requested data.

Request for data from payers or providers to determine how to deliver care for a particular patient, group or community.

Request for data from payers or other providers to assess of social risk, establishing coded health concerns/problems, creating patient driven goals, managing interventions, and measuring outcomes.

Existing concepts do not define a more detailed Healthcare Operations as defined by HIPAA. Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.

[Existing concepts do not define a more detailed Payment as defined by HIPAA. Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.

Existing concepts do not define a more detailed Treatment as defined by HIPAA. Therefore, implicit in using this code is that an implementer must supply an additional, alternate code.

Purpose of use for the requested data.

Flag to indicate whether the requested data requires a signature.

A business identifier that ties requested attachments back to the claim or prior-authorization (referred to as the “re-association tracking control numbers”).

Flag to indicate whether the requested data can be submitted in multiple transactions. If true the data can be submitted in separate transactions. if false all the data should be submitted in a single transaction.

$submit-attachment operation endpoint where the requested data can be submitted

Date of service or starting date of the service for the claim or prior authorization.

A Task by a Payer requesting attachments for a Provider claim or prior-authorization using LOINC attachment codes.

A Task requesting data using a code.

A Task requesting data using FHIR query syntax.

A Task requesting data using a data request questionnaire (FHIR Questionnaire).

A Task by a Payer requesting attachments or additional data for a Provider claim or prior-authorization using a data request questionnaire (FHIR Questionnaire).