Da Vinci Clinical Data Exchange (CDex)
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Da Vinci Clinical Data Exchange (CDex), published by HL7 International / Payer/Provider Information Exchange Work Group. This guide is not an authorized publication; it is the continuous build for version 2.1.0-preview built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-ecdx/ and changes regularly. See the Directory of published versions

Using CDex Attachments with DaVinci PAS

Page standards status: Informative

Introduction

In Da Vinci Prior Authorization Support (PAS), the expectation is that a final decision is generated immediately and automatically in the majority of cases. However, a payer may request additional information (aka attachements) from the provider to support a prior authorization request. See the Request for Additional Information section in the PAS Implementation Guide.

Differences between PAS and CDex

The PAS guide leverages CDex for requesting additional information for prior authorization:

  • Uses CDex’s $submit-attachment operation to push the attachments to the Payer.
  • Requests attachments using Codes or Questionnaires
  • Uses a Task as a context parameter to launch a Smart on FHIR DTR app.

However, there are several key differences:

  PAS CDEX
FHIR resource use by Payer/Intermediary to request additional information PAS Claim Response Bundle CDex Task Attachment Request Profile
Task Profile PAS Task CDex Task Attachment Request Profile
Author of Task Provider Payer
Primary function of Task Launch context for DTR SMART on FHIR App. Communicate request for additional information

When to Use PAS or CDex for Requesting Attachments for Prior Authorization

The decision tree in Figure 1 below summarizes when to Use PAS or CDex for requesting attachments for prior authorization:

Figure 1
pas_cdex_decision_tree.svg

  1. Use PAS, When implementing Da Vinci Burden reduction for prior authorization and the prior authorization request is ‘pended’ and additional information is requested from the provider with a X12 278 Response or [PAS Response Bundle].
  2. Use CDex, When the Provider uses some other channel to request a prior authorization (e.g., fax, portal, phone).
  3. Use CDex, If the Payer makes subsequent requests for additional information after using PAS for the initial request.