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|
|Save the date: Da Vinci Education & FHIR® Implementation Event - April 26 - 30|
|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!
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
|Meeting Topics for today||Formulary Updates|
Call for Volunteers from Implementer Community to deep dive on these trackers.
Background: Formulary IG was written originally to support an open Access API and the shopping experience. The Rule came out to focus Formulary behind Patient Access API and for a specific Patient.
So, thinking about the scenarios for the Patient Access API per patient request example:
Member Auth. - the payer that is putting all these data out through one end point (as part of the CMS Rule) - this is the base URL. This is showing the complete picture, this isn't saying that the Formulary is dependent on Claims and Clinical data. We are assuming the formulary provided is the one that the patient is on. (there should only be one.)
If the patient is searching for a drug that is not part of their plan, they it would return a "not found" response here.
The other example for shopping:
Is there a requirement to show group plan as well as individual plans? Group plans are specific to group sponsor... Group plans should not be part of the shopping experience since a patient cannot subscribe to it yet?
Formulary is on Rx Norm.
|Update on Patient Consent discussion from last week|
Do you envision aligning with the DS for P approach?
Acknowledgement of consent of edge to edge.
Jason from EverNorth - "Consent" may not be the right word - this is more of an authorization process?
Exchange the way it happened between the two parties is a consent resource.
Path for authorization could start at the old or new payer.
Server-to-server communications this is covered entity to covered entity
Discussion on what the right pattern to use is.
Recommendation to discuss further on the Architecture call next week with implementers. Michael Gould will add to that agenda. (Da Vinci internal meeting) will elaborate on the conversation there.
|Implementer Support Questions (PDex, Formulary, Plan Net)|
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:
2) Ask questions live on the call
3) Edit and add your question to this page (in this box under "Question")
Questions to be reviewed and responded to,
From Chat: Hello Everyone! For Payer to Payer Exchange and for Inbound Data Payer is obligated to accept from Payer B. We anticipate the data from Payer B that will be in non-FHIR format, like Excel File, PDF etc, How can we connect with Other External Payers (Payer-B) have a basic idea for type of non-FHIR data they plan to send to Payer A.
Are we obligated to accept non-fhir content? See CMS Final Rule Questions and Answers log the first few responses 1002-1004 may be helpful.
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
Discussion on Rules:
Stanley shared a helpful WEDI webinar on the proposed CMS Rules that folks may be interested in.
Note recent announcement impacting changes to HIPAA regulations that we support an old plan sharing information with new plan at patients request.
FAQ Review Cont. and Implementer Support
|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 - 2/19/2021 Status: Questions submitted, awaiting response for CMS.
- Mark ScrimshireProvide an update Zulip chat link for PDex.
Attendees - 39
Rakesh Mathew Daniel Lilavois Patricia R Harbin Shalabh Gautam Kamaraj Kaliaperumal, Carefirst Bhanu Vemuri Narasimha Murthy Accenture Google Cloud Healthcare Maggie Mellon Courtney Bland HealthLX
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 Virali Accenture Sean Mahoney MITRE Raj Sankurati Ngan MacDonald Narasimha Murthy Pasupuleti Lauren ^ Diane Bengtson-Tate TCS Consultancy Services Christopher Marchand Aashish Bhatt
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 Independent Health 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 Angie Brandon Bryan Briegal IBM Watson Health ACP Breatrice Thompson Hema Srinivasa Kristin Ashby Nag Sanivarapu Abhishek Pandey Shailesh Prabhu Travis Hendrix Zakir Guler
Scott M. Robertson