Da Vinci Prior Authorization Support (PAS) FHIR IG, published by HL7 International / Financial Management. 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-pas/ and changes regularly. See the Directory of published versions

Credits

Page standards status: Informative

Da Vinci

Da Vinci is an HL7-sponsored project that brings together U.S. payers, providers, and technology suppliers to help payers and providers improve clinical, quality, cost, and care management outcomes using FHIR-related technologies. The project organizes meetings (face-to-face and conference calls) and connectathons to find ways to leverage FHIR technologies to support and integrate value-based care (VBC) data exchange across communities. Da Vinci identifies value-based care use cases of interest to its members and to the broader community.

The process that Da Vinci has adopted includes:

1. identifying business, clinical, technical, and testing requirements
2. developing and balloting a FHIR-based implementation guide (IG)
3. developing reference implementations (RIs) to demonstrate that the concepts in the IG are possible to implement
4. piloting the standard
5. supporting the production use of the IG to enable exchange of data to support interoperability for value-based care

All Da Vinci work adheres to a common set of guiding principles.

Additional information about Da Vinci, its members, the use cases, and the implementation guides being developed can all be found on the HL7 website. Meeting minutes and other materials can be found on the Da Vinci Confluence page.

The Da Vinci PAS project

PAS is part of a set of projects in the Burden Reduction space that was first initiated by Da Vinci members in May of 2019. Project participants have included major EHR vendors, payers, provider organizations, and others involved in the prior authorization space. The first standard for trial use version of the specification was published in 2020 and the specification has undergone considerable testing at various connectathons, pilots, and production implementations since then. Further details about the project, including minutes of meetings can be found on the project Confluence page.

Credits

Primary author:

• Jean Duteau (Dogwood Health Consulting)
• Mary Kay McDaniel

Guide Author Support:

• Lloyd McKenzie (Dogwood Health Consulting)

Project leads:

• Robert Dieterle (Enable Care, LLC)
• Viet Nguyen (Stratametrics, LLC)

Project management and coordination:

• Jocelyn Keegan (Point of Care Partners)
• Sachin Bhatt (Point of Care Partners)

Reference implementation:

• Gary Gryan (MITRE), Pat LaRocque (MITRE), Ben Langley (MITRE) and Jason Walonoski (MITRE)

This implementation guide was created under the supervision and review of the HL7 Financial Management (sponsor) and Attachments (co-sponsor) work groups.

This implementation guide was initiated and created with the support of the twenty-two founding [Da Vinci Project] (http://www.hl7.org/about/davinci/index.cfm?ref=common) member organizations.

Organizational participants included:

• AMA (Heather McComas, Terry Cunningham)
• Anthem (Barbara Antuna, Alberto Llanes, Christol Green, Karen Zapata, Mary Bushman, Sudhir Nair)
• Azuba (Bart Carlson)
• Blue Cross Blue Shield of Alabama (Kelly Anderson, Kevin Lambert, Tony Benson)
• Blue Cross Blue Shield of Illinois (Durwin Day, Michael Novales)
• Blue Cross Blue Shield of Michigan (Cindy Monarch, Dawn Perreault, Duane Walker, John Bialowicz)
• Blue Cross Blue Shield of Texas (Brian Poteet, Dylan Tuggle, Susan Langford)
• Cambia (David DeGandi, Jodie Zellerhoff)
• Council for Affordable Quality Healthcare (Emily EnEyck, Rachel Goldstein, Robert Bowman, Taha Anjarwalla)
• Carradora (Michael Flanigan)
• Cerner (Hans Buitendijk)
• Cigna (Marci Maisano, Megan Soccorso)
• Centers for Medicare & Medicaid (Emily Calvert, Erica Ross, Lorraine Doo, Melanie Combs-Dyer, Michael Cabral, Melanie Jones, Scott Lawrence, Thomas Kessler)
• Cognosante (Mary Kay McDaniel, Louis Bedor)
• eClinicalWorks (Phranil Mehta, Rohit Shinde)
• Edifecs (John Kelly, Lindee Chin)
• EMDI/Scope Info Tech (Briana Barnes, Nandini Ganguly, Pallavi Talekar, Ray Wilkerson)
• Epic (Spencer Utley)
• Healow (Ralph Saint-Phard)
• Humad (Monse Serenil)
• Humana (Amy Peterson, Chris Jones, Patrick Murta, Michelle Zutterman, Mike Funk)
• Independence Blue Cross (Michael Gould, Nita Thingalaya)
• Intersystems (Clayton Lewis, Mark Mundt, Lynda Rowe, Russel Leftwich)
• Mettle Solutions (Deepthi Reddy, Sreekanth Puram)
• Optum (Ann Gallagher, Joseph Quinn, Linda Michaelsen, Tony Little)
• Palmetto gba (Robin Igett)
• Point of Care Partners (Dana Marcelonis)
• Surescripts (Jeremy Barnard, Missy Boser, Joseph Athman)
• United Healthcare (Anupam Goel)
• Welcare (Tori Willows)
• WPS Health Solutions (Laurie Burckhardt, Tammy Schreiner)
• ZeOmega (Bonnie Sirott, Tony Sheng)

Additional regular participants: Christy Dodson, Peter Muir, Rachel Foerster, Raj, Rim Cothern

Our thanks to these and to the many others not explicitly listed who contributed their time, enthusiasm and expertise to this work.