hair: Mark Scrimshire
Scribe: Vanessa Candelora
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."
Minutes Approved as Presented
Meeting Minutes from Discussion
|Decision Link(if not child)|
|Management||Review ANSI Anti-Trust Policy|
Da Vinci April Education Session
Register Here - Early Bird Registration by 4/5/21
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
|Implementer Support Questions (PDex, Formulary, Plan Net) - 30min|
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")
|Reviewed FAQ Proposed Responses|
0005 - Conversation to add to the discoverable end points work as part of FAST - standard API and IG for access to end points. the capability statements
Each end point (two sperate servers) with capability statements - PBM provided the Pharmacy directory.
We could also have both on one server with single end point; one server with multiple end points with a hit that drives how the end point behaves
Multiple capability statements gets confusing, no single way to see what all the capabilities of an organization overall are, it's per server, per end point. Searching in provider directory by searching the
Why is pharmacy split out? what about other carve outs... others like Mental health, etc.
Rule says: If a payer has a provider network, regardless of if it's served by a carve out or not, then it should be included in the directory.
PBM is a very common one and per the rule, it's ok to have two separate directories.
Send in a query parameter to distinguish which kind of instance to do your query against. within a single directory, they are separated by health care service... different directories/ end point by PBM and by payer.
Does the 340B Pharmacy program - does the rule cover that?
Summary - the mental health and over carve outs would be included in the main directory.
Recap of above:
Reviewed and finalized 0006 and 0007 as well.
|How to ensure Plan IDs are unique if not HIOS-based?|
not discussed today.
|Formulary Open tickets update|
FHIR-31579 - Getting issue details... STATUS -
Proxy NDC being used to fill in RXNorm.
When submissions go, there is an NDC that is used to represent that particular drug. The proxy NDC, defined by CMS, can change so would have to change it.
If change to extensible, it allows for new drugs without RxNorm codes to use NDC codes, then when it's available, it would be updated to the RxNorm.
The binding says what needs to be present. may want ot set rules around timing from RxNorm code publication and the time you want it updated in your registry. The bindging sets the expectation.
NDC code not in value set just in the coding.
Wouldn't have RxNorm - change to extensible.
Primary purpose of the formulary is to:
Extensible, if no RXNorm exists, you can you anything (PBM, etc.)
Enteral nutrition doesn't have an RxNorm code.
Cardinality would stay the same.
Certain NDC codes have
Summary next steps: Make it extensive and provide some guidance. Next Step: David Hill will write it down and bring it to Pharmacy review.
|Patient Authorization / Consent of data share|
not discussed today.
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
FAQ Review Cont. and Implementer Support
Consent Discussion Cont. (if updates from Architecture Group)
Adjourned at 12:58pm EST.
|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 - 3/4/2021 Response Received!
- Mark ScrimshireProvide an update Zulip chat link for PDex.
- Action Item 3/5: Do we need a separate shopping access for those members that are enrolled with group plans already that still may have formulary options and want to shop. May use the coverage record to tell you which one you are actually on. Discussed today 3/12 David Hill Robert Dieterle
Attendees - 38
Intepro Solutions 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 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 Caitlyn Campi FL Blue Diane Bengtson Sean Mahoney MITRE Balaji Richard Lisseveld Shanna Hartman CMS Kevin Day Edifecs
Patricia R Harbin
Google Cloud Healthcare
Chris Johnson Scott M. Robertson David Clowers Anthony Omosule Accenture
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 Angie Brandon Bryan Briegal ACP Beatrice Thompson Hema Srinivasa Kristin Ashby Aetna Nag Sanivarapu Abhishek Pandey Shailesh Prabhu Travis Hendrix Dr. First Zakir Guler Jason VanderJagt edifecs Erika Wagner
Scott M. Robertson