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

Table of Contents

0 Table of Contents

1 Home

2 Background

3 Use Cases

3.1 Prior Authorization Questionnaire Use Case

4 Architectural Guidance

5 Query Management

5.1 Authoring Documentation

5.2 Patterns

5.2.1 Condition Patterns

5.2.2 Coverage Patterns

5.2.3 Patient Patterns

5.3 Usage

6 Downloads

7 Tooling Support

8 Testing

9 Changes

10 Downloads

11 License

12 Artifacts Summary

12.1

12.2

12.3

12.4

12.5

12.6

12.7

12.8

12.9

12.10

12.11 Example Patient and Coverage Questionnaire

12.12 Genetic/Molecular testing preauthorization request

12.13 Medical Benefit Outpatient Drug Authorization Form

12.14 Medical Necessity For Authorization Of Catheters

12.15 Humana Uniform Pharmacy Prior Authorization Request Form

12.16 null (Bundle)

12.17 null (Bundle)

12.18 null (Bundle)

12.19 null (Bundle)

12.20 null (Bundle)

12.21