Health Insurance Information
Data related to an individual’s insurance coverage for health care.
Data Element
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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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| 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. |
| Estimate the breadth of applicability of the use case(s) for this data element
|
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 |
- Improving patient experience of care (quality and/or satisfaction)
- Improving the health of populations
- Reducing the cost of care
- Improving provider experience of care
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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
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| 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
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| Extent of exchange
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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. |
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