HL7 Electronic Health Record System Functional Model, Release 2.1.1
2.1.1-ballot - Normative Ballot

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## : AS.8.3 Support Integration of Cost/Financial information into Patient Care (Function) - JSON Representation

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    {
      "resourceType" : "Requirements",
      "id" : "EHRSFMR2-AS.8.3",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/FMFunction"
        ]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <span id=\"description\"><b>Statement <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Normative Content\" class=\"normative-flag\">N</a>:</b> <div><p>Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows.</p>\n</div></span>\n\n    \n    <span id=\"purpose\"><b>Description <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Informative Content\" class=\"informative-flag\">I</a>:</b> <div><p>The provider is alerted or presented with the most cost-effective services, referrals, devices, etc., to recommend to the patient. This may be tailored to the patient's health insurance/plan coverage rules. Medications may be presented in order of cost, or the cost of specific interventions may be presented at the time of ordering.</p>\n</div></span>\n    \n\n    \n    <span id=\"actors\"><b>Actors:</b><br/> ehr</span>\n    \n\n    \n    <span id=\"requirements\"><b>Criteria <a href=\"https://hl7.org/fhir/versions.html#std-process\" title=\"Normative Content\" class=\"normative-flag\">N</a>:</b></span>\n    \n    <table id=\"statements\" class=\"grid dict\">\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>AS.8.3#01</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>MAY</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system MAY provide the ability to extract formularies, preferred providers, and other information, from internal or external sources, that are associated with a patient's health care plan and coverage so that the provider can offer cost effective alternatives to patients.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>AS.8.3#02</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>MAY</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>AS.8.3#03</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>MAY</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>AS.8.3#04</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>MAY</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system MAY provide the ability to render expected patient out-of- pocket cost information for medications, diagnostic testing, and procedures, from internal or external sources, that are associated with a patients health care plan and coverage.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>AS.8.3#05</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>MAY</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system MAY provide the ability to render a notification of an alert to the provider of care where formularies, preferred provider and other information indicate the health plan requires an alternative.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n        <tr>\n            <td style=\"padding-left: 4px;\">\n                \n                <span>AS.8.3#06</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\">\n                \n                \n                \n                <span>SHOULD</span>\n                \n            </td>\n            <td style=\"padding-left: 4px;\" class=\"requirement\">\n                \n                <span><div><p>The system SHOULD conform to function <a href=\"Requirements-EHRSFMR2-AS.9.3.html\">AS.9.3</a> (Support Service Authorizations) to integrate support of prior authorization processes.</p>\n</div></span>\n                \n                \n            </td>\n        </tr>\n        \n    </table>\n</div>"
      },
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
          "valueCode" : "ehr"
        }
      ],
      "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/Requirements/EHRSFMR2-AS.8.3",
      "version" : "2.1.1-ballot",
      "name" : "AS_8_3_Support_Integration_of_Cost_Financial_information_into_Patient_Care",
      "title" : "AS.8.3 Support Integration of Cost/Financial information into Patient Care (Function)",
      "status" : "active",
      "date" : "2025-04-04T11:04:36+11:00",
      "publisher" : "HL7 International / Electronic Health Records",
      "contact" : [
        {
          "telecom" : [
            {
              "system" : "url",
              "value" : "http://www.hl7.org/Special/committees/ehr"
            }
          ]
        }
      ],
      "description" : "Support interactions with other systems, applications, and modules to enable the use of cost management information required to guide users and workflows.",
      "jurisdiction" : [
        {
          "coding" : [
            {
              "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
              "code" : "001",
              "display" : "World"
            }
          ]
        }
      ],
      "purpose" : "The provider is alerted or presented with the most cost-effective services, referrals, devices, etc., to recommend to the patient. This may be tailored to the patient's health insurance/plan coverage rules. Medications may be presented in order of cost, or the cost of specific interventions may be presented at the time of ordering.",
      "statement" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
              "valueBoolean" : false
            }
          ],
          "key" : "EHRSFMR2-AS.8.3-01",
          "label" : "AS.8.3#01",
          "conformance" : [
            "MAY"
          ],
          "conditionality" : false,
          "requirement" : "The system MAY provide the ability to extract formularies, preferred providers, and other information, from internal or external sources, that are associated with a patient's health care plan and coverage so that the provider can offer cost effective alternatives to patients.",
          "derivedFrom" : "EHR-S_FM_R1.1 S.3.2.3#1"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
              "valueBoolean" : false
            }
          ],
          "key" : "EHRSFMR2-AS.8.3-02",
          "label" : "AS.8.3#02",
          "conformance" : [
            "MAY"
          ],
          "conditionality" : false,
          "requirement" : "The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines.",
          "derivedFrom" : "EHR-S_FM_R1.1 S.3.2.3#2"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
              "valueBoolean" : false
            }
          ],
          "key" : "EHRSFMR2-AS.8.3-03",
          "label" : "AS.8.3#03",
          "conformance" : [
            "MAY"
          ],
          "conditionality" : false,
          "requirement" : "The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines."
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
              "valueBoolean" : false
            }
          ],
          "key" : "EHRSFMR2-AS.8.3-04",
          "label" : "AS.8.3#04",
          "conformance" : [
            "MAY"
          ],
          "conditionality" : false,
          "requirement" : "The system MAY provide the ability to render expected patient out-of- pocket cost information for medications, diagnostic testing, and procedures, from internal or external sources, that are associated with a patients health care plan and coverage.",
          "derivedFrom" : "EHR-S_FM_R1.1 S.3.2.3#3"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
              "valueBoolean" : false
            }
          ],
          "key" : "EHRSFMR2-AS.8.3-05",
          "label" : "AS.8.3#05",
          "conformance" : [
            "MAY"
          ],
          "conditionality" : false,
          "requirement" : "The system MAY provide the ability to render a notification of an alert to the provider of care where formularies, preferred provider and other information indicate the health plan requires an alternative.",
          "derivedFrom" : "EHR-S_FM_R1.1 S.3.2.3#4"
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent",
              "valueBoolean" : false
            }
          ],
          "key" : "EHRSFMR2-AS.8.3-06",
          "label" : "AS.8.3#06",
          "conformance" : [
            "SHOULD"
          ],
          "conditionality" : false,
          "requirement" : "The system SHOULD conform to function [AS.9.3](Requirements-EHRSFMR2-AS.9.3.html) (Support Service Authorizations) to integrate support of prior authorization processes.",
          "derivedFrom" : "EHR-S_FM_R1.1 S.3.2.3#5"
        }
      ]
    }