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 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

Introduction

The Da Vinci Burden Reduction Implementation Guides (IGs), Da Vinci Coverage Requirements Discovery (CRD), Da Vinci Documentation Templates and Rules (DTR), and [Da Vinci Prior Authorization Support (PAS)], support an integrated workflow to enable automated submission of required documentation and prior authorization from EHR and payer systems respectively. In [Da Vinci Prior Authorization Support (PAS)], a final decision is expected to be generated immediately and automatically in most cases. However, a payer may request additional information (aka attachments) 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 to request additional information for prior authorization:

• PAS and CDex use the $submit-attachment operation to push the attachments to the Payer.
• PAS and CDex request attachments using Codes or Questionnaires.
• PAS and CDex Use Task as a context parameter to launch a Smart on FHIR DTR app.

However, there are several key differences:

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:

1. Use PAS when implementing Da Vinci Burden reduction for prior authorization, the initial authorization request is 'pended', and additional information is requested from the Provider with an X12 278 Response or [PAS Response Bundle].
2. Use CDex when the Provider uses another 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.

[Da Vinci Prior Authorization Support (PAS)]: [CDex Work Queue Value Set]: ValueSet-cdex-work-queue.html [What is Signed]: signatures.html#what-is-signed [Signatures for Task Based Requests]: task-based-approach.html#signatures [X12]: https://x12.org/ [X12 transactions]: https://x12.org/ [X12 Transaction Sets]: https://x12.org/products/transaction-sets [HEDIS]: https://en.wikipedia.org/wiki/Healthcare_Effectiveness_Data_and_Information_Set [Specification]: specification.html [$match]: http://hl7.org/fhir/R4/patient-operation-match.html [Coverage]: http://hl7.org/fhir/R4/coverage.html [FHIR RESTful Search syntax]: http://hl7.org/fhir/R4/search.html#Introduction [DocumentReference]: http://hl7.org/fhir/R4/documentreference.html [FHIR Signature]: http://hl7.org/fhir/R4/datatypes.html#signature [Bundle.signature]: http://hl7.org/fhir/R4/bundle-definitions.html#Bundle.signature [enveloped signature]: http://www.w3.org/TR/xmldsig-core/#def-SignatureEnveloped [(Verification Signature)]: http://hl7.org/fhir/R4/valueset-signature-type.html [FHIR Document]: http://hl7.org/fhir/R4/documents.html [RFC 7515]: https://tools.ietf.org/html/rfc7515 [JSON Signature rules]: http://hl7.org/fhir/R4/datatypes.html#JSON [RFC 7515: JSON Web Signature (JWS)]: https://tools.ietf.org/html/rfc7515 [Detached]: https://tools.ietf.org/html/rfc7515#appendix-F [Canonical JSON]: http://hl7.org/fhir/R4/json.html#canonical [JWS JSON Serialization]: https://datatracker.ietf.org/doc/html/rfc7515#section-3.2 [X.509 certificates]: https://www.itu.int/rec/T-REC-X.509 [RFC 7518]: https://tools.ietf.org/html/rfc7518 [RFC 7517]: https://tools.ietf.org/html/rfc7517 [RFC 8785]: https://datatracker.ietf.org/doc/rfc8785 [self-signed certificates]: https://en.wikipedia.org/wiki/Self-signed_certificate [Signed SearchSet Bundle Example]: signed-searchset-bundle-example.html [Signed Document Bundle Example]: signed-document-bundle-example.html [FHIR-36158]: https://jira.hl7.org/browse/FHIR-36158 [Solicited and Unsolicited Attachments]: solicited-unsolicited-attachments.html [Sending Attachments]: sending-attachments.html [Requesting Attachments Using Attachment Codes]: requesting-attachments-code.html [Requesting Attachments Using Questionnaires]: requesting-attachments-questionnaire.html [Using Questionnaire as Task Input]: task-based-approach.html#using-questionnaire-as-task-input [Using CDex Attachments with DaVinci PAS]: burden-reduction.html [CDex Task Attachment Request Profile]: StructureDefinition-cdex-task-attachment-request.html [LOINC attachment codes]: https://loinc.org/attachments/ [Parameters]: http://hl7.org/fhir/R4/parameters.html [CDex Patient Demographics Profile]: StructureDefinition-cdex-patient-demographics.html [CDex Claim Use Value Set]: ValueSet-cdex-claim-use.html [Prior-Auth AttachmentRequest Example]: Task-cdex-task-example20.html [Claim AttachmentRequest Example]: Task-cdex-task-example19.html [CDex Temporary Code System]: CodeSystem-cdex-temp.html [NHIN Purpose Of Use Code System]: http://hl7.org/fhir/R4/codesystem-nhin-purposeofuse.html [LOINC Document Ontology]: https://loinc.org/document-ontology/ [CDex Signature Bundle Profile]: StructureDefinition-cdex-signature-bundle.html [FHIR RESTful search]: http://hl7.org/fhir/R4/http.html#search [FHIR RESTful read]: http://hl7.org/fhir/R4/http.html#read [Change Log]: changes.html [CDex Parameters Example1]: Parameters-cdex-parameters-example1.html [CDex Parameters Example2]: Parameters-cdex-parameters-example2.html [CDex Parameters Example3]: Parameters-cdex-parameters-example3.html [CDex Parameters Example4]: Parameters-cdex-parameters-example4.html [validating profiles and resources]: http://hl7.org/fhir/R4/validation.html [ImplementationGuide]: http://hl7.org/fhir/R4/implementationguide.html [CDex ImplementationGuide Resource]: ImplementationGuide-hl7.fhir.us.davinci-cdex.html [Da Vinci DTR]: http://hl7.org/fhir/us/davinci-dtr/2.1.0-preview [Questionnaire]: http://hl7.org/fhir/R4/questionnaire.html [Smart Version 2.0.0 EHR launch flow]: https://hl7.org/fhir/smart-app-launch/app-launch.html#launch-app-ehr-launch [Using Da Vinci DTR to Complete the Questionnaire]: requesting-attachments-questionnaire.html#using-da-vinci-dtr-to-complete-the-questionnaire [Conforming to CDex Attachments]: attachments-conformance.html [Request for Additional Information]: /additionalinfo.html [SDC Questionnaire Response Profile]:http://hl7.org/fhir/uv/sdc/STU3StructureDefinition-sdc-questionnaireresponse.html [SDC Adaptive Questionnaire Response Profile]:http://hl7.org/fhir/uv/sdc/STU3StructureDefinition-sdc-questionnaireresponse-adapt.html [45 CFR 164.506 Treatment, Payment, and Health Care Operations (TPO)]: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-164/subpart-E/section-164.506 [must support]: http://hl7.org/fhir/us/davinci-hrex/STU1.1/conformance.html [DTR SMART App Launch]: requesting-attachments-questionnaire.html#dtr-smart-app-launch [Conforming to CDex Task Based Approach]: task-based-conformance.html [Signature Extension]: http://hl7.org/fhir/StructureDefinition/questionnaireresponse-signature [DTR Standard Questionnaire]: http://hl7.org/fhir/us/davinci-dtr/2.1.0-previewStructureDefinition-dtr-std-questionnaire.html [signatureRequired]: http://hl7.org/fhir/StructureDefinition/questionnaire-signatureRequired [CDex Signature Profile]: StructureDefinition-cdex-signature.html [CDex SDC QuestionnaireResponse Profile]: StructureDefinition-cdex-sdc-questionnaireresponse.html [QuestionnaireResponse]: http://hl7.org/fhir/R4/questionnaireresponse.html [Topic-Based Subscriptions Framework]: http://hl7.org/fhir/2022Sep/subscriptions.html [C-CDA on FHIR Documents]: http://www.hl7.org/fhir/us/ccda/index.html [FHIR Conformance]: http://hl7.org/fhir/R4/conformance-rules.html#conflang [Must Support]: http://hl7.org/fhir/R4/profiling.html#mustsupport [modifier elements]: http://hl7.org/fhir/R4/conformance-rules.html#isModifier [CDex PractitionerRole Profile]: StructureDefinition-cdex-practitionerrole.html [CDex Task Update]: SubscriptionTopic-cdex-task-update.html [Subscription R5 Backport Implementation Guide]: http://hl7.org/fhir/uv/subscriptions-backport/STU1.1 [SubscriptionTopic]: https://hl7.org/fhir/R4B/subscriptiontopic.html [CapabilityStatement SubscriptionTopic Canonical]: http://hl7.org/fhir/uv/subscriptions-backport/STU1.1/StructureDefinition-capabilitystatement-subscriptiontopic-canonical.html [Conformance in FHIR R4]: http://hl7.org/fhir/uv/subscriptions-backport/STU1.1/conformance.html#conformance-in-fhir-r4 [R4/B Topic-Based Subscription Profile]: http://hl7.org/fhir/uv/subscriptions-backport/STU1.1/StructureDefinition-backport-subscription.html [R4 Topic-Based Subscription Notification Bundle]: http://hl7.org/fhir/uv/subscriptions-backport/STU1.1/StructureDefinition-backport-subscription-notification-r4.html [HRex Task Status ValueSet]: http://hl7.org/fhir/us/davinci-hrex/STU1.1/ValueSet-hrex-task-status.html [Task.businessStatus]: http://hl7.org/fhir/R4/task-definitions.html#Task.businessStatus [Benefits]: task-based-approach.html#benefits [Task Inputs and Outputs]: task-based-approach.html#task-inputs-and-outputs [Purpose of Use]: task-based-approach.html#purpose-of-use [Task Reason]: task-based-approach.html#task-reason [Discovery of Identifiers]: task-based-approach.html#discovery-of-identifiers [Task State Machine]: task-based-approach.html#task-state-machine [Approaches to Exchanging FHIR Data]: https://hl7.org/fhir/R5/exchanging.html [PAS Claim Response Bundle]: /StructureDefinition-profile-pas-response-bundle.html [PAS Task]: /StructureDefinition-profile-task.html [Patient Matching]: https://hl7.org/fhir/us/identity-matching/patient-matching.html [Guidance on Identity Assurance]: https://hl7.org/fhir/us/identity-matching/guidance-on-identity-assurance.html [Interoperable Digital Identity and Patient Matching]: https://hl7.org/fhir/us/identity-matching/index.html [CQL]: https://cql.hl7.org/ [Da Vinci Use Cases]: https://confluence.hl7.org/display/DVP/Da+Vinci+Use+Cases [FHIR R4 core]: http://hl7.org/fhir/R4/fhir-spec.zip [FHIR core downloads]: http://hl7.org/fhir/R4/downloads.html [validator]: https://fhir.github.io/latest-ig-validator/org.hl7.fhir.validator.jar [instructions on how to use it]: https://confluence.hl7.org/display/FHIR/Using+the+FHIR+Validator