PPA+Assumptions,+Pre+and+Post+Conditions

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= The content within this page has been incorporated into the PPA UC 1 - Provider Registration =

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 * NOTE: The content developed and displayed on this page will be inserted into the Use Case document in the highlighted sections below: **

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Use Case 1 - Provider Registration request to receive electronic medical documentation request (eMDR)

 * 5.0 Assumptions – UC 1 **
 * 1) The electronic provider registration request will be in a structured electronic format (to be determined through harmonization process).
 * 2) Providers will be identified by their National Provider Identifier (NPI) for registration. In the absence of an NPI, other unique provider identification can be used.
 * 3) Each provider registration request is for one individual or entity identified by a single NPI. In the absence of an NPI, other unique provider identification can be used.
 * 4) The External Provider Directory can be a Provider's Internal PD, Payer entity’s Internal PD, or provided by a third party like Council for Affordable Quality Healthcare (CAQH), Regional Health Information Organization (RHIO) or Health Information Exchange (HIE) Provider Directory (PD) (community or state).
 * 5) Gateways, if used by the payer, will support provider registration activities.
 * 6) All transactions will follow national standards.
 * 7) All transactions will have appropriate security to ensure data is transmitted securely, reliably, and with authentication of both the sender and receiver.
 * 8) Providers and/or Agents will register ESI information with the appropriate PD.
 * 9) Registration will not expire, but may be subject to reasonable update and termination conditions as determined by each payer.


 * 6.0 Pre-Conditions - UC 1 **
 * 1) Provider or Agent can submit all required information electronically to payer entity to begin registration process.
 * 2) Payer entity can receive and process electronic request for registration.
 * 3) Provider entity or Agent supports the required transaction and payload standards for the registration request.
 * 4) Participating entities have completed any required on boarding processes and signed any required participation or data use agreements.
 * 5) Payer internal information systems are established and in place for timely information verification.
 * 6) External Provider Directories are established and in place for timely information verification.
 * 7) External Provider Directories have the ability to receive information request queries sent from payer entities, process them, and respond back to payers using the S&I PD data sets.
 * 8) Payer entities can receive and process ESI information from External Provider Directories.
 * 9) Providers or Agents can receive and act on registration request confirmations (both affirmative and rejection) from Payer entities.


 * 7.0 Post Conditions - UC **
 * 1) Providers and Agents will maintain the ability to receive electronic MDRs after successful registration.
 * 2) Provider registration information is maintained by the payer and available for use by the payer or other users of the provider registration system.

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