Chair: 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
|HL7 May Connectathon - Save the date May 17 - 19|
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!
|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")
|Formulary Open Items / Discussion|
1) FHIR-28293 How to ensure PlanIDs are unique if not HIOS-based? -
2) FHIR-30924 – Cost Sharing description
3) FHIR-31672 - will provide guidance
4) Follow-up on Action item from 4/2 - FHIR-31579 - Change binding to RxNorm to extensible to accommodate new drugs - Share specific examples where there is a drug on a formulary that does not have an RXNorm code yet - Courtney B., Rob M.,
No examples shared today, so still waiting for input. Please share any examples you have for where there is a drug on a formulary that does not have an RXNorm code yet.
Goal to have pends down 4/19 and an STU Update released for Formulary in June.
|Additional Topics||Reviewed FAQ Proposed Responses|
|Consent Discussion Cont. (if updates from Architecture Group)|
Update on Member Match - including optional consent resource as part of the request. Architecture call yesterday approved the id of adding an optional resource for the member match specification.
Addresses the problem discussed in the past: When member signs up for new plan and they request to the new plan that the member has data be shared from the old plan
Pass a resource that they have the consent of the member to go and request that data. Covered entity to covered entity.
Defining a consent profile to be included. the new payer would include it in the membermatch request along with the patient resource, coverage resource for new plan, coverage resource for old plan, and now an optional Consent resource. It would be a business by business decision to trust that data to confirm legal requirements are met.
Payers on the call are not feeling like they can trust the consent resource and may still add an additional step for patients to attest that their data can be shared as needed by their own legal requirements. If you are in this position, please participate in Connectathon and join the conversation to resolve the issue and avoid additional patient burden.
Exchange between two payers are secure and identifiable. This needs to happen anyway, separate from this piece. The intent on this consent resource addition is for the old payer to know that the new payer has consent from the patient that they want their data shared.
New Use Case for Connectathon - desire to mask certain information that is sensitive, this could be an upcoming use case.
Plan is to add the optional consent resource (may may required in the future but not with pending regulation at this time) into HRex membermatch as there are no objections.
Thanks all for the feedback on the value of this addition, please join us on Wednesdays at the CDex calls where HRex is also discussed. Health Record Exchange Framework (HRex)
|Exploring options to incorporate PA into PDex - Bob - PDex updates for PA.docx||Goal: trying to get something that is implementable and not too disruptive to PDex that will meet the need of the CMS Rule (final rule from January is currently pended) - Reference: Proposed Rule Fact Sheet|
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
Adjourned at pm 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
- FHIR-28293 - David Hillreach out to Margaret or someone at NCPDP to join next week's call to discuss how this is done with NCPDP.
- 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 - 47
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 Sai Bagewadi Cognizant Kechia Scott Kerri Wing Krithika Kumar Accenture Don Zacharia Evernorth
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 CVS Health Hema Srinivasa Kristin Ashby Aetna Nag Sanivarapu Abhishek Pandey Shailesh Prabhu Travis Hendrix Dr. First Zakir Guler Jason VanderJagt edifecs Erika Wagner Shamil Nizamov Michael Robinson Christopher Marchand Chris Busch Nathaniel Hosenpud Christopher Roedocker SKYGEN
Scott M. Robertson