HL7 Electronic Health Record System Functional Model, Release 2.1.1
2.1.1-ballot - Normative Ballot International flag

HL7 Electronic Health Record System Functional Model, Release 2.1.1, published by HL7 International / Electronic Health Records. This guide is not an authorized publication; it is the continuous build for version 2.1.1-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ehrsfm-ig/ and changes regularly. See the Directory of published versions

: AS.8.3 Support Integration of Cost/Financial information into Patient Care (Function) - XML Representation

Page standards status: Informative

Raw xml | Download


<Requirements xmlns="http://hl7.org/fhir">
  <id value="EHRSFMR2-AS.8.3"/>
  <meta>
    <profile
             value="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/FMFunction"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
    <span id="description"><b>Statement <a href="https://hl7.org/fhir/versions.html#std-process" title="Normative Content" class="normative-flag">N</a>:</b> <div><p>Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows.</p>
</div></span>

    
    <span id="purpose"><b>Description <a href="https://hl7.org/fhir/versions.html#std-process" title="Informative Content" class="informative-flag">I</a>:</b> <div><p>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.</p>
</div></span>
    

    
    
    

    
    <span id="requirements"><b>Criteria <a href="https://hl7.org/fhir/versions.html#std-process" title="Normative Content" class="normative-flag">N</a>:</b></span>
    
    <table id="statements" class="grid dict">
        
        <tr>
            <td style="padding-left: 4px;">
                
                <span>AS.8.3#01</span>
                
            </td>
            <td style="padding-left: 4px;">
                
                
                
                <span>MAY</span>
                
            </td>
            <td style="padding-left: 4px;" class="requirement">
                
                <span><div><p>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.</p>
</div></span>
                
                
            </td>
        </tr>
        
        <tr>
            <td style="padding-left: 4px;">
                
                <span>AS.8.3#02</span>
                
            </td>
            <td style="padding-left: 4px;">
                
                
                
                <span>MAY</span>
                
            </td>
            <td style="padding-left: 4px;" class="requirement">
                
                <span><div><p>The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines.</p>
</div></span>
                
                
            </td>
        </tr>
        
        <tr>
            <td style="padding-left: 4px;">
                
                <span>AS.8.3#03</span>
                
            </td>
            <td style="padding-left: 4px;">
                
                
                
                <span>MAY</span>
                
            </td>
            <td style="padding-left: 4px;" class="requirement">
                
                <span><div><p>The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines.</p>
</div></span>
                
                
            </td>
        </tr>
        
        <tr>
            <td style="padding-left: 4px;">
                
                <span>AS.8.3#04</span>
                
            </td>
            <td style="padding-left: 4px;">
                
                
                
                <span>MAY</span>
                
            </td>
            <td style="padding-left: 4px;" class="requirement">
                
                <span><div><p>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.</p>
</div></span>
                
                
            </td>
        </tr>
        
        <tr>
            <td style="padding-left: 4px;">
                
                <span>AS.8.3#05</span>
                
            </td>
            <td style="padding-left: 4px;">
                
                
                
                <span>MAY</span>
                
            </td>
            <td style="padding-left: 4px;" class="requirement">
                
                <span><div><p>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.</p>
</div></span>
                
                
            </td>
        </tr>
        
        <tr>
            <td style="padding-left: 4px;">
                
                <span>AS.8.3#06</span>
                
            </td>
            <td style="padding-left: 4px;">
                
                
                
                <span>SHOULD</span>
                
            </td>
            <td style="padding-left: 4px;" class="requirement">
                
                <span><div><p>The system SHOULD conform to function <a href="Requirements-EHRSFMR2-AS.9.3.html">AS.9.3</a> (Support Service Authorizations) to integrate support of prior authorization processes.</p>
</div></span>
                
                
            </td>
        </tr>
        
    </table>
</div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
    <valueCode value="ehr"/>
  </extension>
  <url value="http://hl7.org/ehrs/uv/ehrsfmr2/Requirements/EHRSFMR2-AS.8.3"/>
  <version value="2.1.1-ballot"/>
  <name
        value="AS_8_3_Support_Integration_of_Cost_Financial_information_into_Patient_Care"/>
  <title
         value="AS.8.3 Support Integration of Cost/Financial information into Patient Care (Function)"/>
  <status value="active"/>
  <date value="2025-08-29T14:03:55+00:00"/>
  <publisher value="HL7 International / Electronic Health Records"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="http://www.hl7.org/Special/committees/ehr"/>
    </telecom>
  </contact>
  <description
               value="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 value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
      <display value="World"/>
    </coding>
  </jurisdiction>
  <purpose
           value="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."/>
  <statement>
    <extension
               url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
      <valueBoolean value="false"/>
    </extension>
    <key value="EHRSFMR2-AS.8.3-01"/>
    <label value="AS.8.3#01"/>
    <conformance value="MAY"/>
    <conditionality value="false"/>
    <requirement
                 value="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 value="EHR-S_FM_R1.1 S.3.2.3#1"/>
  </statement>
  <statement>
    <extension
               url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
      <valueBoolean value="false"/>
    </extension>
    <key value="EHRSFMR2-AS.8.3-02"/>
    <label value="AS.8.3#02"/>
    <conformance value="MAY"/>
    <conditionality value="false"/>
    <requirement
                 value="The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines."/>
    <derivedFrom value="EHR-S_FM_R1.1 S.3.2.3#2"/>
  </statement>
  <statement>
    <extension
               url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
      <valueBoolean value="false"/>
    </extension>
    <key value="EHRSFMR2-AS.8.3-03"/>
    <label value="AS.8.3#03"/>
    <conformance value="MAY"/>
    <conditionality value="false"/>
    <requirement
                 value="The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines."/>
  </statement>
  <statement>
    <extension
               url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
      <valueBoolean value="false"/>
    </extension>
    <key value="EHRSFMR2-AS.8.3-04"/>
    <label value="AS.8.3#04"/>
    <conformance value="MAY"/>
    <conditionality value="false"/>
    <requirement
                 value="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 value="EHR-S_FM_R1.1 S.3.2.3#3"/>
  </statement>
  <statement>
    <extension
               url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
      <valueBoolean value="false"/>
    </extension>
    <key value="EHRSFMR2-AS.8.3-05"/>
    <label value="AS.8.3#05"/>
    <conformance value="MAY"/>
    <conditionality value="false"/>
    <requirement
                 value="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 value="EHR-S_FM_R1.1 S.3.2.3#4"/>
  </statement>
  <statement>
    <extension
               url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
      <valueBoolean value="false"/>
    </extension>
    <key value="EHRSFMR2-AS.8.3-06"/>
    <label value="AS.8.3#06"/>
    <conformance value="SHOULD"/>
    <conditionality value="false"/>
    <requirement
                 value="The system SHOULD conform to function [AS.9.3](Requirements-EHRSFMR2-AS.9.3.html) (Support Service Authorizations) to integrate support of prior authorization processes."/>
    <derivedFrom value="EHR-S_FM_R1.1 S.3.2.3#5"/>
  </statement>
</Requirements>