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) - XML Representation

Page standards status: Informative

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    <Requirements xmlns="http://hl7.org/fhir">
      <id value="EHRSFMR2-AS.8.3"/>
      <meta>
        <profile
                 value="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/FMFunction"/>
      </meta>
      <text>
        <status value="extensions"/>
        <div xmlns="http://www.w3.org/1999/xhtml">
        <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>
    </div></span>

        <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>
    </div></span>

        <span id="actors"><b>Actors:</b><br/> ehr</span>

        <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>

        <table id="statements" class="grid dict">

            <tr>
                <td style="padding-left: 4px;">

                    <span>AS.8.3#01</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>MAY</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <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>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>AS.8.3#02</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>MAY</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <span><div><p>The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines.</p>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>AS.8.3#03</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>MAY</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <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>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>AS.8.3#04</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>MAY</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <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>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>AS.8.3#05</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>MAY</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <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>
    </div></span>

                </td>
            </tr>

            <tr>
                <td style="padding-left: 4px;">

                    <span>AS.8.3#06</span>

                </td>
                <td style="padding-left: 4px;">

                    <span>SHOULD</span>

                </td>
                <td style="padding-left: 4px;" class="requirement">

                    <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>
    </div></span>

                </td>
            </tr>

        </table>
    </div>
      </text>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/structuredefinition-wg">
        <valueCode value="ehr"/>
      </extension>
      <url value="http://hl7.org/ehrs/uv/ehrsfmr2/Requirements/EHRSFMR2-AS.8.3"/>
      <version value="2.1.1-ballot"/>
      <name
            value="AS_8_3_Support_Integration_of_Cost_Financial_information_into_Patient_Care"/>
      <title
             value="AS.8.3 Support Integration of Cost/Financial information into Patient Care (Function)"/>
      <status value="active"/>
      <date value="2025-04-04T11:04:36+11:00"/>
      <publisher value="HL7 International / Electronic Health Records"/>
      <contact>
        <telecom>
          <system value="url"/>
          <value value="http://www.hl7.org/Special/committees/ehr"/>
        </telecom>
      </contact>
      <description
                   value="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 value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
          <code value="001"/>
          <display value="World"/>
        </coding>
      </jurisdiction>
      <purpose
               value="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 value="false"/>
        </extension>
        <key value="EHRSFMR2-AS.8.3-01"/>
        <label value="AS.8.3#01"/>
        <conformance value="MAY"/>
        <conditionality value="false"/>
        <requirement
                     value="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 value="EHR-S_FM_R1.1 S.3.2.3#1"/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-AS.8.3-02"/>
        <label value="AS.8.3#02"/>
        <conformance value="MAY"/>
        <conditionality value="false"/>
        <requirement
                     value="The system MAY provide the ability to extract information about exemptions on coverage limitations and guidelines."/>
        <derivedFrom value="EHR-S_FM_R1.1 S.3.2.3#2"/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-AS.8.3-03"/>
        <label value="AS.8.3#03"/>
        <conformance value="MAY"/>
        <conditionality value="false"/>
        <requirement
                     value="The system MAY provide the ability to capture or transmit the request for information about exemptions on coverage limitations and guidelines."/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-AS.8.3-04"/>
        <label value="AS.8.3#04"/>
        <conformance value="MAY"/>
        <conditionality value="false"/>
        <requirement
                     value="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 value="EHR-S_FM_R1.1 S.3.2.3#3"/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-AS.8.3-05"/>
        <label value="AS.8.3#05"/>
        <conformance value="MAY"/>
        <conditionality value="false"/>
        <requirement
                     value="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 value="EHR-S_FM_R1.1 S.3.2.3#4"/>
      </statement>
      <statement>
        <extension
                   url="http://hl7.org/ehrs/uv/ehrsfmr2/StructureDefinition/requirements-dependent">
          <valueBoolean value="false"/>
        </extension>
        <key value="EHRSFMR2-AS.8.3-06"/>
        <label value="AS.8.3#06"/>
        <conformance value="SHOULD"/>
        <conditionality value="false"/>
        <requirement
                     value="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 value="EHR-S_FM_R1.1 S.3.2.3#5"/>
      </statement>
    </Requirements>