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Healhcare Information Technology Standards Panel

HealthCare Information Technology Standards Panel

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HITSP operates under contract to the U.S. Department of Health and Human Services (HHS).

Capability

CAP 141 - Communicate Referral Authorization

This Capability addresses interoperability requirements that support electronic inquiry and response to authorizing a patient (health plan member) to be referred for service by another provider or to receive a type of service or medication under the patient’s health insurance benefits. The Capability supports the transmittal of a patient’s name and insurance identification number with the request for the type of service. It also includes the following optional requirements: • Identification of the type of service or medication requested for benefit coverage (does not guarantee payment by insurance provider) • Communication of a referral notification number or authorization number from the Payer System to the Provider System It provides clinicians and pharmacists with information about each patient’s medical insurance coverage and benefits. It may include information on referral or authorization permission.

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Construct	Title / Version	Referenced by	Status	Document Access
CAP 141	Communicate Referral Authorization Version:1.0	IS 9 V:1.0.2 IS 7 V:1.1.1 IS 91 V:0.0.1	Released (Panel Approved)	DOWNLOAD

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Reference Documents

Acronyms
AHIC Use Cases
Conventions (naming and numbering)
Glossary
Harmonization Framework
Interoperability Specifications Overview