Common CQL Artifacts for FHIR (US-Based)
1.0.0 - Informative 1 United States of America flag

This page is part of the Common CQL Assets for FHIR (US-Based) (v1.0.0: Informative 1 - Informative) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

Examples

Page standards status: Informative

Prior-Authorization Questionnaire Examples

This implementation guide includes several worked examples of prior authorization questionnaires:

  • Example Patient and Coverage Questionnaire

    For the Prior Authorization Questionnaire Use Case, this type of in-context information is expected to be known already so it wouldn't typically be in a Questionnaire. This example illustrates how to get this information if it is needed.

  • Example Genetic/Molecular Testing Preauthorization Questionnaire

    This is an example of a prior authorization questionnaire developed based on an existing industry prior-authorization form.

  • Example Medical Benefit Outpatient Drug Authorization Questionnaire

    This is an example of a prior authorization questionnaire developed based on an existing industry prior-authorization form.

  • Example Medical Necessity For Authorization Of Catheters Questionnaire

    This is an example of a prior authorization questionnaire developed based on an existing industry prior-authorization form.

  • Example Uniform Pharmacy Prior Authorization Request Form

    This is an example of a prior authorization questionnaire developed based on an existing industry prior-authorization form.

    • The examples above are informed by freely available prior-authorization forms downloaded from Humana's prior authorization support portal and used with permission. These examples demonstrate the use of CQL expressions as part of the prior-authorization use case.

    For information on how these examples can be tested, see the Testing page in this implementation guide.

    Examples for Other Use Cases

    Examples for other use cases are maintained as part of specifications detailing those use cases: