HL7 Electronic Health Record System Functional Model, Release 2.1.1
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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/mvdzel/ehrsfm-fhir-r5/ and changes regularly. See the Directory of published versions

Requirements: AS.9.3 Support Service Authorizations (Function)

Page standards status: Informative
Statement N:

Support interactions with other systems, applications, and modules to enable the creation of requests, responses and appeals related to service authorization, including prior authorizations, referrals, and pre-certification.

 Description I:

Retrieves information needed to support verification of medical necessity and prior authorization of services at the appropriate juncture in the encounter workflow. Improves timeliness of patient care and reduces claim denials.

 Criteria N:
AS.9.3#01 SHOULD

The system SHOULD provide the ability to capture service authorizations relevant to the service provided including the source, dates, and service(s) authorized.
AS.9.3#02 SHOULD

The system SHOULD provide the ability to capture referrals relevant to the service provided including the source, date and service(s) referred.
AS.9.3#03 dependent MAY

The system MAY provide the ability to exchange computer readable data on service authorizations according to scope of practice, organizational policy, and/or jurisdictional law.
AS.9.3#04 dependent MAY

The system MAY provide the ability to exchange computer readable data on service referral information according to scope of practice, organizational policy, and/or jurisdictional law.
AS.9.3#05 SHOULD

The system SHOULD provide the ability to export electronic referral(s), including relevant supporting clinical information from care providers internal or external to the organization.
AS.9.3#06 MAY

The system MAY provide the ability to export electronic referral(s), including relevant supporting administrative information from care providers internal or external to the organization.