FHIR to reduce burden and solve prior authorization challenges
summary
HL7 Da Vinci provides three live implementation guides — Coverage Requirements Discovery, Documentation Templates and Rules, and Prior Authorization Support — that automate prior auth by using SMART on FHIR + CDS Hooks to launch apps, CQL to pull patient data, adaptive questionnaires to stop when enough evidence exists, and a Claim resource or FHIR bundle as the submission/attachment mapped to X12. Pilots (e.g., MultiCare/Cambia/Providence) show queues of hundreds reduced; clinicians spend 3–5 hours/week on admin and ~$3k/yr on prior auth per physician.
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chapters (8)
- 0:00Introduction to FHIR and burden reduction
- 3:10Da Vinci project overview
- 10:31Coverage requirements discovery guide
- 13:39Documentation templates and rules guide
- 17:12Prior authorization support guide
- 22:31Developer resources and community support
- 27:29CMS adoption and certification questions
- 35:35Future of administrative data exchange
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