2021-02-05 PDex Meeting

Da Vinci Implementer Support Page

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!

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? 

• Add it - stays aligned with QHP formulary
• Don't add it - it's a significant change to the IG, need to figure out the best timing and approach if this is the direction we take.  

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.

• Need a standard way to find both end points and for clients to find both at run time, want to avoid trying to direct the request.  
• The rule allows for more than one end point.
• Other Implementers are having an instructional webpage to help people know where to go. 
• Setup a proxy with an interface with third party developers that is publicly available
• Talk about timeline in response on Monday's internal coordination call and circle back to the group. Vanessa Candelora

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: 

• Enrollment - new payer requesting from old payer - membermatch required
• Member can go back to the prior payer to request info be sent to the end point - don't need to match the member that way, could use the OAth Process.  
• Member match is a SHALL - guide is written with new payer going to old payer. 

Robert Dieterle Mark Scrimshire

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

PDex IG Companion Guide - Laboratory Reporting Resources

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

Find initial questions and corresponding answers shared from our colleagues at CMS here