| Submitted By: Shelly Spiro / Pharmacy HIT Collaborative | |
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| Data Element Information | |
| Use Case Description(s) | |
| Use Case Description | With the Pharmacist eCare Plan it is required to capture the coverage.payor when sharing and exchanging eCare Plans to capture clinical data for payor value-based programs. |
| Estimated number of stakeholders capturing, accessing using or exchanging | There are over 70 payor programs currently with CPESN (https://www.cpesn.com) which is a network of over 2600 pharmacies. |
| Link to use case project page | https://www.ecareplaninitiative.com/ |
| Healthcare Aims |
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| Maturity of Use and Technical Specifications for Data Element | |
| Applicable Standard(s) | Coverage type and self paid codes; Many of the defined elements in a resource are references to other resources. Using these references, the resources combine to build a web of information about healthcare; ID assigned to the subscriber http://hl7.org/fhir/valueset-coverage-type.html |
| Additional Specifications | http://hl7.org/fhir/coverage.html |
| Current Use | This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders |
| Supporting Artifacts |
The CPESN network of over 2600 pharmacies are capturing coverage.payor data within the Pharmacist eCare Plan (hitps://www.ecareplaninitiative.com). https://www.cpesn.com |
| Number of organizations/individuals with which this data element has been electronically exchanged | 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders. |
| Supporting Artifacts |
The CPESN network of over 2600 pharmacies are capturing coverage.payor data within the Pharmacist eCare Plan (hitps://www.ecareplaninitiative.com). https://www.cpesn.com |
| Potential Challenges | |
| Restrictions on Standardization (e.g. proprietary code) | Based on the HL7 FHIR eCare Plan implementation guide. |
| Restrictions on Use (e.g. licensing, user fees) | For SNOMED CT UMLS license |
| Privacy and Security Concerns | None known. |
| Estimate of Overall Burden | Burden is linked to the implementation of the FHIR standards. |
Data related to an individual’s insurance coverage for health care.
Data Element |
Information from the submission form |
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| Payer Name |
Description
The program or plan underwriter or payor including both insurance and non-insurance agreements, such as patient-pay agreements.
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