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Req-252: Administrative Transaction Processing
Release Package: 2013 Format


Release Package:

2013 Format

Requirement ID:

Req-252

Title:

Administrative Transaction Processing

Description:

STATEMENT: Support the creation (including using external data sources, if necessary), electronic interchange, and processing of transactions listed below that may be necessary for encounter management during an episode of care.
DESCRIPTION: Support the creation (including using external data sources, if necessary), electronic interchange, and processing of transactions listed below that may be necessary for encounter management during an episode of care.
· The EHR system shall capture the patient health-related information needed for administrative and financial purposes including reimbursement.
· Captures the episode and encounter information to pass to administrative or financial processes (e.g. triggers transmissions of charge transactions as by-product of on-line interaction including order entry, order statusing, result entry, documentation entry, medication administration charting).
· Automatically retrieves information needed to verify coverage and medical necessity.
· As a byproduct of care delivery and documentation: captures and presents all patient information needed to support coding. Ideally performs coding based on documentation.
· Clinically automated revenue cycle - examples of reduced denials and error rates in claims.
· Clinical information needed for billing is available on the date of service.
· Physician and clinical teams do not perform additional data entry / tasks exclusively to support administrative or financial processes.

Related Requirements:

Relationship Release Package Requirement ID Requirement Title Requirement Type SHALL / SHOULD / MAY Compare Requirements
Req-252 Is Parent Of 2013 Format Req-251 Health Service Reports at the Conclusion of an Episode of Care Function Not Applicable Compare
Req-252 Is Child Of 2013 Format Req-285 Administrative and Financial Header Not Applicable Compare
Req-252 Is Parent Of Req-785 Enrollment of Patients Not Applicable Compare
Req-252 Is Parent Of Req-786 Eligibility Verification and Determination of Coverage Function Not Applicable Compare
Req-252 Is Parent Of Req-787 Claims and Encounter Reports for Reimbursement Not Applicable Compare
Req-252 Is Parent Of Req-794 Service Authorizations Function Not Applicable Compare

Topic Area(s):

Provenance:

HL7 EHR FM R1

Achievability:

Requirement Type:

Function

Shall/Should/May:

Critical/Core:

No

Status:

Released

Links:

Not Provided

See Also:

Not Provided

Comments:

Not Provided

Additional Information:

Not Provided

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Last Updated 04/13/2016
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