HL7 FHIR Implementation Guide: Simplify Health Equity Application Reviews IG Release 1 - US Realm | STU1
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HL7 FHIR Implementation Guide: Simplify Health Equity Application Reviews IG Release 1 - US Realm | STU1 - Local Development build (v0.1.0). See the Directory of published versions

$Process-Message Operation

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The Process Message Operation will receive a completed Questionnaire. The bundle will contain a MessageHeader and the QuestionnaireResponse.

The Message Header will identify the bundle as a SHEAR Needs Assessment Screener (QuestionnaireResponse). The Screener can be submitted by a Provider or Community Based Organization (CBO), or an agent of the CBO.

The SHEAR Assessment Screener sub-operation will:

  • Evaluate the responses
  • If all information is provided and meet the screening criteria the request will be approved.
  • If information is provided and the screening criteria are not met a denial will be provided back to the submitter.
  • If the sub-operation is unable to make a determination, for example, due to missing data. The bundle will be posted for manual review.

The manual review step would create a task resource that links to the Questionnaire resource.

The Manual Review would result in an approval or denial. Approvals and denials will result in the same responses back to the submitter as processed via the automated evaluation.

Approved Submission

When a submission is approved the operation will create or update the following resources:

  • Create Prior Authorization (Based on PDex STU2 ExplanationOfBenefit Profile).
  • Update Group record for Provider/CBO Organization.
  • Update Group record for Service Delivery Organization (if different from the Provider/CBO Organization).
  • Optionally create a CarePlan record for the Member. This would be accessible to the member via the Patient Access API.

The Group records are used to update the attribution of members to Providers or other service organizations. This will enable those organizations to use the Provider API to retrieve data for the members they are supporting. Data would be retrieved using the Bulk FHIR API.

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