Chair: Mark Scrimshire
Scribe: Vanessa Candelora
Minutes Approved as Presented
This is to approve minutes via general consent. "You have received the minutes. Are there any corrections to the minutes? (pause) Hearing none, if there are no objections, the minutes are approved as printed."
Meeting Minutes from Discussion
|Decision Link(if not child)|
|Management||Review ANSI Anti-Trust Policy|
|IG Publishing Updates|
Implementers can take advantage of tools: See the Reference links on the Payer Data Exchange (PDex) page to access links for Reference Implementations, sandboxes, test scripts, and more!
|Formulary Recent Questions and JIRA Trackers created per Zulip|
|Implementer Support Questions (PDex, Formulary, Plan Net)|
Call to All Implementers: Please come with your questions! Options:
1) Ask questions live on the call
2) Edit and add your question to this page (in this box)
3) Send them to us on Zulip:
We learn as a community and iterate on the IGs through real world experience, so your contributions are welcome!
Question: Reviewed created ticket: https://jira.hl7.org/browse/FHIR-30924 - Reviewed this. We have some plans with no deductible, when trying to look at co-pay, using before and after deductible doesn't apply, what's the recommendation for those fields?
Situation where there is no deductible or co-insurance. Can't we use the same after deductible. It's after $0. Add comments to this tracker based on this feedback.
Add to the IG as a narrative within an errata or technical correction update (no ballot needed)
Change to English (not the value set) for the situation where deductible doesn't exist.
Added n/a as an option for a preventative medicine with no cost sharing?
Question: We are following DaVinci Plan net IG for provider directory. We are looking for a solution to distinguish and Separate out the Pharmacy directory from Provider directory. One of the options /solutions we are looking at, can we enforce OrganizationAffliation.Role as a mandatory search parameter in Location API to help distinguish between pharmacy and Provider. Are we deviating from the Davinci IG. Is there a plan in future to provide a guidance in IG to help distinguish the pharmacy & provider? Heard CARIN is going something similar for Pharmacy and medical claims based on profile
Discussion: Need combination of search parameters If you are searching pharmacies associated with a pharmacy-provider network.
Could use approach suggested and direct a subset of queries the client sends to some, but it wont work for all since they may say "I want to read location #7 without other indicators on whenever it's a pharmacy or not."
Use Case: Monthly download of the full directory to see changes. Don't blind the pharmacies.
PBMs supply pharmacy directories. Other source for the Provider Directory.
Summary: It is acceptable to have two entries for two separate directories in capability statement - one pointing to pharmacies and one pointing to the provider entry points.
Question: Extension: Email Plan Contact
Jira Tracker Created: https://jira.hl7.org/browse/FHIR-30933
Tracker to be added Saul Kravitz - Change to Plan Contact URL Extension. the definition should include how to have an email as a url.
Change to Support Contact instead of Email Plan Contact and then add to the description that it could point to a url or an email
Question: Member Match for Payer to Payer in the use case where a member would move to a new payer and want info from us (the old payer), can we use authentication with the digital ID in place of membermatch.
Two use cases in coming rule:
We have a medication measure that using NPI. Looking at claims resources, two options:
1) Doc provider off backbone
2) doc care team off backbone
Preferred method for documenting Provider NPI or Identifying info?
Are you asking about claim or EOB? Rule every payer needs to implement the EOB (CARIN BB IG). The other way you're asking every payer to implement something additional to the rule. EOB was designed to implement for customer member view, avoiding confidential info masking needs.
PDex IG Links and Updates
PDex Supplemental Guides
Updated to 0.1.29 on build.fhir.org: http://build.fhir.org/ig/HL7/davinci-epdx/index.html.
Source code is here: https://github.com/HL7/davinci-epdx
Presented to FM on 10/20
Adjourned at 1:00pm ET
|PDex Companion Guides||PDex IG Companion Guide List|
|CARIN CPCDS to US Core Mapping|
Latest draft CARIN CPCDS Mapping document: CARIN Mapping to FHIR interim 2020 0513.xlsx
DRAFT - PDEX US Core Mapping from CPCDS source: ResourceMappingUSCoreCPCDS-2020-05-29-v26.xlsx
|PDex - US Core |
Source PowerPoint: PDEXandUSCoreRelationship.pptx
|Da Vinci is seeking answers to open questions and clarifications needed on the implementation and operational needs of the upcoming CMS Patient Directed API Rules.|
Find initial questions and corresponding answers shared from our colleagues at CMS here
- PDex Pharmacy list - pharmacy count and mix: how can the pharmacy count and mix (as required by CMS) be included in the response PDex resources? Scott M. Robertson posted question 2020-11-20 PDex Meeting - VC reached back to out MG and Bob on status,
Rakesh Mathew Daniel Lilavois Patricia R Harbin Shalabh Gautam Kamaraj Kaliaperumal, Carefirst Bhanu Vemuri Narasimha Murthy Accenture Google Cloud Healthcare Maggie Mellon Courtney Bland
Present Name Affiliation CMS BCBST Deepthi Reddy Mettle Solutions Allscripts Eric Sullivan Inovalon MITRE India Duncan Optum Availity Susan Lestina AHA Bob Bowman CAQH Thomas Kessler CMS Patrick Edwards Briana Barnes Scope Info Tech Kishore Metla Mettle Solutions John Donnelly Interpro Lorraine Doo CMS Melanie Jones CMS Rim Cothren Yolanda Villanova CMS Manoj Kumar BCBSFL MITRE Srinivas Konchada Centene Corporation Sheryl Turney Anthem Helina Gebremariam Mike Novales BCBSIL Ric Light Humana Ann Gallagher Optum Chris Klesges Mitre Adam Gronsky Health Fidelity CaseNet Anthem CMS eClinicalWorks Healow Interfaceware Mark Rucci Spectramedix Anthem Cindy Monarch BCBSM Michael Kim Cognosante Jim Catan Accenture BCBSA Jia Chen Robert Dieterle Jeff Eastman Ernestine Cooper Jason Teeple CIGNA Lloyd McKenzie Mary Winter Rachel E. Foerster Tom Grannan Azuba Tony Benson BCBS AL Independence BC Henry Archibong Inovalon HL7 Consultant Abdul Sattar Anirudh Choudhary Todd Biske ESI Darrell Woelk Doug Stoss Rick Lisseveld Aegis LakshminarayananSaravanan Laurie Burckhardt WPS Health Plan Kevin Lynch Inovalon Joseph Minieri MITRE Durwin Day BCBS IL Pamela West Ravi Thakkar Aetna UO Aetna Swati Nanda Aetna CVS Health Cyrus Kevin MITRE Fred Harmon Ready Computing Blue Cross NC Michael Ryan NCQA HealthSparq CVS/Aetna Dorothy Lee NCQA Khoa Nguyen Suma Addagadde BCBSNC
Patricia R Harbin
Google Cloud Healthcare
Chris Johnson Scott M. Robertson David Clowers
Present Name Affiliation Nancy Spector AMA Bruce Wilkinson Benmedica Avality BCBSAL MCG ONC Surescripts NCPDP Anupam Thakur BCBSFL Jonathan Hutchins BCBST Anthem Sunitha Godavarthi Christopher Gracon x12 Labcorp James Derrickson Intersystems Cognizant Neetha Joseph Cognizant Kaiser Permanente MITRE Rutika Express Scripts Brody Brodock Allscripts Michael Brody CME Online Theressa Baumann BCBS AL Mona Chandrapal eClinicalWorks Optum Aakash Deliwala eClinicalWorks Mayo Epic Shaheer Stanley Nachimson Anthony Smith UNC Health Howard Cohen Minaei Behnaz FDA BCBSA Shilesh Nair gdit NewWave MaxMD BC Idaho Edward Castagna Altarum Andrea Kent CoverMyMeds Carrie Denny Kim Pham Celine Lefebvre AMA Edifecs Josh Lamb UPMC Keya Shah Casenet Gevity MITRE Mrugen Mehta eClinicalWorks Revathi Jayakumuar Supriya Bapi Bhera Matt Dyer Vyne Sree Vijetha Vegi C-HIT BCBSA Rich Bloch Lumedic Cigna Paul Knapp Ron Urwongse CAQH Anand Raghavan HealthLX Ezequiel Morles Frank McKinney Hanna ? Brett Rauschke Carolyn McKinney Clarissa Winchester BCBS AL JC HealthShare Exchange (HSX) River Wong Rob McClure MD Partners Ronald Wampler Derrick Woolridge Beata Ferraiz Ed Donaldson Consultant with Humana Julie Burgoon Mark Neumuth Aetna Raj Sankuratri Aetna Dr. Cheryl D. Lohman Germantown, MD | Family Physician Barbara Valeno Eshaa Dhall eclinicalworks
Scott M. Robertson