{ "resourceType" : "Requirements", "id" : "DHFPR2-AS.8.3", "meta" : { "profile" : ["http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/FMFunction"] }, "language" : "en", "text" : { "status" : "extensions", "div" : "
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Description I:

The provider is alerted or presented with the most cost-effective services, referrals, devices, etc., to recommend to the patient. This may be tailored to the patient's health insurance/plan coverage rules. Medications may be presented in order of cost, or the cost of specific interventions may be presented at the time of ordering.

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Criteria N:
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\n AS.8.3#01\n \n MAY\n \n \n \n \n \n \n \n \n

The system MAY provide the ability to extract formularies, preferred providers, and other information, from internal or external sources, that are associated with a patient's health care plan and coverage so that the provider can offer cost effective alternatives to patients.

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\n AS.8.3#02\n \n MAY\n \n \n \n \n \n \n \n \n

The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines.

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\n AS.8.3#03\n \n MAY\n \n \n \n \n \n \n \n \n

The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines.

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\n AS.8.3#04\n \n MAY\n \n \n \n \n \n \n \n \n

The system MAY provide the ability to render expected patient out-of- pocket cost information for medications, diagnostic testing, and procedures, from internal or external sources, that are associated with a patients health care plan and coverage.

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\n AS.8.3#05\n \n MAY\n \n \n \n \n \n \n \n \n

The system MAY provide the ability to render a notification of an alert to the provider of care where formularies, preferred provider and other information indicate the health plan requires an alternative.

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\n AS.8.3#06\n \n SHOULD\n \n \n \n \n \n \n \n \n

The system SHOULD conform to function AS.9.3 (Support Service Authorizations) to integrate support of prior authorization processes.

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" }, "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status", "valueCode" : "informative" }, { "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-change-info", "valueCode" : "NC" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg", "valueCode" : "ehr" }, { "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm", "valueInteger" : 1, "_valueInteger" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom", "valueCanonical" : "http://hl7.org/ehrs/us/dhfpr2/ImplementationGuide/hl7.ehrs.us.dhfpr2" }] } }], "url" : "http://hl7.org/ehrs/us/dhfpr2/Requirements/DHFPR2-AS.8.3", "version" : "2.0.0-ballot", "name" : "AS_8_3_Support_Integration_of_Cost_Financial_information_into_Patient_Care", "title" : "AS.8.3 Support Integration of Cost/Financial information into Patient Care (Function)", "status" : "active", "date" : "2025-12-19T08:44:27+00:00", "publisher" : "HL7 International / Electronic Health Records", "contact" : [{ "telecom" : [{ "system" : "url", "value" : "http://www.hl7.org/Special/committees/ehr" }] }], "description" : "Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows.", "jurisdiction" : [{ "coding" : [{ "system" : "urn:iso:std:iso:3166", "code" : "US" }] }], "purpose" : "The provider is alerted or presented with the most cost-effective services, referrals, devices, etc., to recommend to the patient. This may be tailored to the patient's health insurance/plan coverage rules. Medications may be presented in order of cost, or the cost of specific interventions may be presented at the time of ordering.", "derivedFrom" : ["http://hl7.org/ehrs/uv/ehrsfmr2/Requirements/EHRSFMR2-AS.8.3"], "statement" : [{ "extension" : [{ "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent", "valueBoolean" : false }, { "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-change-info", "valueCode" : "NC" }], "key" : "DHFPR2-AS.8.3-01", "label" : "AS.8.3#01", "conformance" : ["MAY"], "conditionality" : false, "requirement" : "The system MAY provide the ability to extract formularies, preferred providers, and other information, from internal or external sources, that are associated with a patient's health care plan and coverage so that the provider can offer cost effective alternatives to patients.", "derivedFrom" : "AS.8.3#1" }, { "extension" : [{ "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent", "valueBoolean" : false }, { "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-change-info", "valueCode" : "NC" }], "key" : "DHFPR2-AS.8.3-02", "label" : "AS.8.3#02", "conformance" : ["MAY"], "conditionality" : false, "requirement" : "The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines.", "derivedFrom" : "AS.8.3#2" }, { "extension" : [{ "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent", "valueBoolean" : false }, { "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-change-info", "valueCode" : "NC" }], "key" : "DHFPR2-AS.8.3-03", "label" : "AS.8.3#03", "conformance" : ["MAY"], "conditionality" : false, "requirement" : "The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines.", "derivedFrom" : "AS.8.3#3" }, { "extension" : [{ "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent", "valueBoolean" : false }, { "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-change-info", "valueCode" : "NC" }], "key" : "DHFPR2-AS.8.3-04", "label" : "AS.8.3#04", "conformance" : ["MAY"], "conditionality" : false, "requirement" : "The system MAY provide the ability to render expected patient out-of- pocket cost information for medications, diagnostic testing, and procedures, from internal or external sources, that are associated with a patients health care plan and coverage.", "derivedFrom" : "AS.8.3#4" }, { "extension" : [{ "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent", "valueBoolean" : false }, { "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-change-info", "valueCode" : "NC" }], "key" : "DHFPR2-AS.8.3-05", "label" : "AS.8.3#05", "conformance" : ["MAY"], "conditionality" : false, "requirement" : "The system MAY provide the ability to render a notification of an alert to the provider of care where formularies, preferred provider and other information indicate the health plan requires an alternative.", "derivedFrom" : "AS.8.3#5" }, { "extension" : [{ "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent", "valueBoolean" : false }, { "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-change-info", "valueCode" : "NC" }], "key" : "DHFPR2-AS.8.3-06", "label" : "AS.8.3#06", "conformance" : ["SHOULD"], "conditionality" : false, "requirement" : "The system SHOULD conform to function [AS.9.3](Requirements-DHFPR2-AS.9.3.html) (Support Service Authorizations) to integrate support of prior authorization processes.", "derivedFrom" : "AS.8.3#6" }] }