2021-04-09 PDex Meeting

Da Vinci April Education Session

Da Vinci Education & FHIR Implementation Event by HL7 - April 26 - 30

Register Here

2021 - 05 Connectathon 27

2021-05 Da Vinci

Any questions?  

1) FHIR-28293 How to ensure PlanIDs are unique if not HIOS-based? - 

• NCPDP Bin codes are not unique. 
• Plan IDs - think: State drivers license numbers - unique within the state. Define the name space (i.e. Colorado) is an option.  Antoehr eg. Bank numbers. How do we do that?
  • We could number the payers and have a payer prefix. then, someone needs to manage that.  Payers don't have identifiers. 
  • ID data type as the system and they manage the ID's within their own system. It works for RxNorm.   
  • Discussion around HPID regulation Master Payer ID effort a few years ago that failed.  SL: The challenge and failure was around the dependency with requirement for a huge part of the industry to force HIPAA compliancy that wasn't previously a part of it - too much to take on for small plans. 
  • How does NCPDP do it on the prescribing side? Bin and PCN. 
  • Here's a list of clearinghouses that we need to get to.  
  • Action Item to reach out to bring Margaret or someone from NCPDP to discuss how they do it on the next call.  

  • Summary of issue: simply having a PlanID be unique within a particular payer space was brought up as a potential issue for PBMs.  We need to have clear confirmation from PBM that only having PlanIDs unique within the individual payer space will not create issues.

2) FHIR-30924 – Cost Sharing description

• short term: add guidance to our FAQ page for the Cost sharing description.
• long term: Evaluating update to IG as STU Update or for next release (2022.) 

3) FHIR-31672 - will provide guidance

• Dave is meeting with CMS Monday to see how pending regulation 

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., 

• generics?
• timing to get on RxNorm... Are we talking days, weeks, months?

Discussion:

• RX Norm codes come from new drugs, not by request. 
• Trail drugs - have a designation from the FDA that is not final approved and those drugs will not have RXNorm codes - RM thinks. 
• Generics should all have RXNorm codes.
  • Off patent - NDC codes would be different for different manufactures but not RxNorm code.  RxNorm code is on a sematic clinical drug - that will have a ingredient(s), strength and form.  Those are the same by every manufacture.    
    • The excipient part of the drug would not be represented in the RXNorm code.
•   NDCs are not governed centrally. 

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. 

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)

PDex IG Links and Updates

PDex Supplemental Guides

PDex IG Companion Guide - Laboratory Reporting Resources

FAQ Review Cont. and Implementer Support

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

• Links to Published IGs

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