CRD: coverage requirements at order time

Coverage answers at order time

The best moment to learn what a payer needs is the moment a clinician places the order. Coverage Requirements Discovery, or C R D, brings the payer's answer into the provider's own screen, while the decision is still being made.

Primary and secondary hooks

C R D uses a standard called CDS Hooks. A hook is a point in the clinician's workflow where the system can call out for help. The guide names six. Three are primary: booking an appointment, signing an order, and dispatching an order. For these, the payer's server must return coverage information. The other three are secondary: selecting an order, starting an encounter, and discharging. For these the payer may answer, and the system is free to ignore it.

A need, and the response type

What can the payer send back? The guide defines several response types. To show a link to the rules, an external reference card. To show text guidance, an instructions card. To update the order itself with coverage details, a coverage information system action. To suggest a different option, a propose alternate request card. And to open a form that needs completing, a request form completion card. There are others, such as launching a SMART application.

• Link to the rules · External reference card · link · navy
• Text guidance · Instructions card · text · navy
• Update the order · Coverage information action · pencil · amber
• Suggest another option · Propose alternate request · share · amber
• A form to complete · Request form completion · file · slate

Actionable beats vague

Cards compete for a busy clinician's attention. The guide says the summary should be actionable, and gives its own examples. Coverage alert is not very helpful. Prior authorization required is better. Longer detail should only appear when the summary cannot say it, and the summary has a limit of one hundred and forty characters.

Check yourself

Pause and think. Which C R D hook fires when a clinician signs an order? The answer: order sign.

• order-sign
• encounter-discharge
• appointment-book
• order-select

Keep these in mind

C R D brings payer answers into the order screen. There are six hooks: three primary and three secondary. Cards and system actions carry the answer. And a good card says what to do next.

• CRD brings payer answers into the order screen
• Six hooks: three primary, three secondary
• Cards and system actions carry the answer
• A good card says what to do next