Clinical Quality Framework Common FHIR Assets (US-Based)
0.1.0 - CI Build United States of America (USA)

Clinical Quality Framework Common FHIR Assets (US-Based), published by Clinical Quality Framework. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cqf-us/ and changes regularly. See the Directory of published versions

Downloads

This implementation guide includes several worked examples of prior authorization questionnaires:

  • Example Patient and Coverage Questionnaire

    For the Prior Authorization Questionnaire Use Case, this type of in-context information is expected to be known already so it wouldn't typically be in a Questionnaire. This example illustrates how to get this information if it is needed.

  • Genetic/Molecular testing preauthorization request

    Automated online preauthorization is available for some tests. Please log into the Availity Portal at Availity.com for a list of available questionnaires. If the appropriate questionnaire is not available, please complete this form.

  • Medical Benefit Outpatient Drug Authorization Form

    Drugs administered by healthcare professionals in an outpatient setting are covered under the Medical Benefit. Information on drugs requiring prior authorization can be found on NaviNet.net or the For Providers section of the Geisinger Health Plan website.

  • Medical Necessity For Authorization Of Catheters

    The Health Care Authority requires this form for all clients requesting sterile closed catheter.

  • Humana Uniform Pharmacy Prior Authorization Request Form

    Humana Uniform Pharmacy Prior Authorization Request Form

    • Other potential examples to be worked include: