Documentation Templates and Rules

The Documentation Templates and Rules (DTR) API provides the EHR the exact forms/questions they need to fill for approval (based on the treatment and patient details) to collect the correct required information.

The POST and GET DTR Questionnaire APIs enable the ability to tell a provider/EHR exactly what clinical documentation is required in the computable form during prior authorization or coverage workflows.

When creating orders, booking appointments, admitting patients, etc., there is often an expectation that certain types of documentation are captured that will subsequently be used for payer processing. This might be information needed for determining prior authorization (or if prior authorization is necessary), for inclusion as part of a claims submission, or even for retention as documentation of 'medical necessity' in the event of a future audit. There are clinical rules for what documentation is necessary and in what form it needs to exist. Failure to capture appropriate documentation or represent it in the correct manner can delay the processing of authorization requests and claims, result in denial of requests, or result in other penalties or hardships for both the provider and their patients.

Questionnaire operations are mechanism to express documentation requirements computably in a way that allows clinicians and other EHR users to navigate and quickly specify the needed information in a context-specific way. For more information, please refer to Da Vinci Documentation Templates and Rules implementation guide.

Endpoint

• POST /dtr/Questionnaire/$questionnaire-package — create a new questionnaire.
• GET /dtr/QuestionnaireResponse/{qr_id} — retrieve payer documentation requirements and/or rules.