2021-02-19 PDex Meeting

• PDex STU 1.0.1
• Plan Net STU 1.0.0
• Formulary - STU 1.0.1

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!

New! Da Vinci PDex for Patient Access API Frequently Asked Questions (FAQs)

Reviewed each response. 

• End Point Directory:
  • Bob provided an update on the status of the End Point Directory's 3 separate IGs
  • Link to FAST Project Tracking: NationalHealthcareDirectory-HL7Project
  • EMAC and UDAP are working on solving registering trusted framework for apps.  Shared by Tony B. via chat: https://drj.com/industry_news/ehnac-and-udap-org-announce-launch-of-trusted-dynamic-registration-authentication-accreditation-program/ 
  • CAQH is the only one we are aware of that is building a Payer End Point Directory
• Member Match - 
  • Old payer sending to new payer -
    • They will have digital IDs and the membermatch does nothing for them. There is no need for it in this scenario. 
  • Under the Proposed Rule (for 1/1/23), member match comes in in the following places: Agreement here. 
    • The new plan will need to request info from old plan. 
    • Ability for patient to request info, where the new plan will need to request from old plan. 
  • For 7/1/2021, you must as the old plan be able to allow a member to request their data to share with whomever they would like.  
  • For 1/1/2022, How will the old payer know, upon patient request, that the new payer has patient authorization for them to release the patient data to the new payer? Some payers are requiring a patient HIPAA authorization prior to releasing the data. 
    • New payer would initiate the transaction to say "my new member wants us to get their data from you (old payer) - this is where membermatch comes in.    
    • You would know as part of a digital entity, that the request is Payer A. Trusting another covered entity
    • Need to education the member of the risk of the release of the information so the Old payer is covered with consent at the time of service and request for their info to be sent to the new payer.  
    • Data is clinical and EOB (without Cost) per proposed rule. 
    • New Proposed Rule:
      • Prior Auth info
      • Provider API.
      • Payer to Payer. 

For a copy of the Proposed Rule Fact Sheet, visit: https://www.cms.gov/newsroom/fact-sheets/reducing-provider-and-patient-burden-improving-prior-authorization-processes-and-promoting-patients

Action Items:

• Explore adding to the IG in a future release or additional guidance for a way to share the confirmation of patient consent of sharing data to the old payer.  Mark Scrimshire

Call for Volunteers from Implementer Community to deep dive on these trackers in a separate call:

Ticket Number For reference (or use this public Jira query link)

• FormularyDrug CoveragePlan Cardinalities FHIR-30923, FHIR-29670
  • Efficiency of representation
  • Aligning FHIR IG (as intended) with QHP Formulary
• Richer Description of Prescription Limits - FHIR-29964
  • Moving from Booleans to small, descriptive valuesets
• Minor changes to Cost Sharing description - FHIR-30924
  • Aligns with current QHP Plan Descriptions
• Plan-Specific Mail Order Flag on Formulary Drug? FHIR-30925
• PlanID Description Refinement FHIR-28293
• Changing String values to URL values (as appropriate) - FHIR-30412
• Changing CoveragePlan.emailPlanContact FHIR-30933
• Support for Marketing URLs for multiple languages -   FHIR-29965

Call to All Implementers: We learn as a community and iterate on the IGs through real world experience, so your contributions are welcome! Please come with your questions. Options:

1) Send them to us on Zulip: 

• PDex: https://chat.fhir.org/#narrow/stream/235286-Da-Vinci.20PDex - may be updated. Mark Scrimshire
• Formulary:  https://chat.fhir.org/#narrow/stream/197730-Da-Vinci.20PDex.20Drug.20Formulary
• Plan Net/ Directory: https://chat.fhir.org/#narrow/stream/229922-Da.2BVinci.2BPDex.2BPlan-Net
• tag Vanessa Candelorato make sure they get to this agenda if not answered. 

2) Ask questions live on the call

3) Edit and add your question to this page (in this box under "Question")

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

• Spreadsheets used to support tables in PDEX IG:

• PDEX-USCore3-1-1-2020-10-20-v5.xlsx
• PDEX-Plannet-formulary-2020-10-20-v3.xlsx
• CARIN Mapping to FHIR interim 2020 0818 v2.xlsx
• Observation-FHIR_R4 v1.4.xlsx

Presented to FM on 10/20

Adjourned at 1pm

Source PowerPoint: PDEXandUSCoreRelationship.pptx